Late recovery of responsiveness after intra-thecal baclofen pump implantation and the role of diffuse pain and severe spasticity: a case report.
Acta Neurochir (Wien)
; 161(9): 1965-1967, 2019 09.
Article
in En
| MEDLINE
| ID: mdl-31267188
ABSTRACT
Patients with a prolonged disorder of consciousness (DoC) may present with severe spasticity and diffuse pain, which might impair motor output, thus preventing any possible behavioral responsiveness. A 26-year-old man affected by frontoparietal hemorrhage was operated by hematoma evacuation and decompressive craniectomy; coma persisted for 1 month; cranioplasty and ventriculo-peritoneal shunting was performed after 4 months. At admission in rehabilitation, he was diagnosed as vegetative state/unresponsive wakefulness syndrome (VS/UWS). The implantation of intrathecal baclofen (ITB) pump (Medtronic SynchroMed™ II), 14 months after, (60 µg/daily), dramatically improved behavioral responsiveness according to Coma Recovery Scale-Revised (CRS-R) from 6 to 12 (1 month after ITB). Nociception Coma Scale-Revised (NCS-R) also changed from 4 to 8 at the same time points. This case report may be an example of covert cognition that should have been diagnosed as a functional locked-in syndrome or motor-cognitive dissociation, rather than as VS/UWS.
Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Baclofen
/
Locked-In Syndrome
/
Muscle Relaxants, Central
/
Muscle Spasticity
Type of study:
Etiology_studies
Limits:
Adult
/
Humans
/
Male
Language:
En
Journal:
Acta Neurochir (Wien)
Year:
2019
Document type:
Article
Affiliation country:
Italy