Meningismus associated with malpositioned intraspinal catheter for drug delivery.

BACKGROUND: Implanted delivery systems for intrathecal drug administration have become more common in the management of nonmalignant pain. Many postprocedural complications have been described in the literature including infection and headache provoked by position changes. Determining the etiology of a postimplant headache is important particularly when considering the possibility of a life-threatening infection. CASE REPORT: We present a patient who underwent placement of an implantable drug delivery system (IDDS) for intractable abdominal pain that developed positional headaches, and significant neck and back pain. Attempted cerebrospinal fluid aspiration reproduced her symptoms and imaging revealed a malpositioned intraspinal catheter tip approximated to the meninges. Revision of the system completely relieved her symptoms. CONCLUSION: Meningismus from malpositioned catheters is a rare complication that can mimic meningitis but should be considered in the differential for postimplant headaches. Given the increased use of IDDS, it is important to recognize and evaluate postimplant complication and treat it appropriately. We discuss this case report and appropriate work-up and differential diagnosis for meningismus following implant.

Trigeminal neuralgia relief with intrathecal ziconotide.

OBJECTIVE: We report a case of a 59-year-old female with severe TN who experienced satisfactory symptom relief from a single-shot trial of intrathecal ziconotide. METHOD: Performed a 1 µg single-shot trial of Prialt. RESULTS: Report of satisfaction, no side effects, and complete face and back relief briefly but most notably relief from the TN. DISCUSSION: Ziconotide should be considered for treatment of TN, although further investigation is recommended.