Encephalopathy of Unknown Origin in a Baclofen Patient: Case Report and Review of the Literature.
Acute Kidney Injury
/ chemically induced
Adult
Anti-Bacterial Agents
/ adverse effects
Baclofen
/ administration & dosage
Brain Diseases
/ chemically induced
Electroencephalography
Fever
/ etiology
GABA-B Receptor Agonists
/ administration & dosage
Humans
Infusion Pumps, Implantable
Infusions, Spinal
Male
Meropenem
/ therapeutic use
Paraplegia
/ complications
Seizures
/ etiology
Spasm
/ drug therapy
Spinal Cord Injuries
/ complications
Vancomycin
/ adverse effects
Acute kidney injury
Baclofen
Encephalopathy
Intrathecal baclofen
Renal disease
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
Apr 2020
Apr 2020
Historique:
received:
06
11
2019
revised:
06
01
2020
accepted:
07
01
2020
pubmed:
20
1
2020
medline:
9
4
2020
entrez:
20
1
2020
Statut:
ppublish
Résumé
Encephalopathy is reported to have affected 250,000 people in the United States over the last decade, with considerable morbidity and mortality. Baclofen, a gamma-aminobutyric acid-B agonist that acts on the central nervous system, is the drug most widely used to treat spasticity. Baclofen overdose is a potentially deadly condition that can cause encephalopathy and can result from multiple etiologies. Renal disease can contribute to baclofen overdose and encephalopathy, and there are currently no dosing recommendations for patient's on baclofen with renal impairment. We report an unusual case of a man aged 35 years who presented with persistent fevers, seizures, and normal mentation. The patient presented with intrathecal baclofen use and prior exposure to West Nile Virus. He developed acute kidney injury at hospital secondary to vancomycin use, and mental status declined. This case highlights that patients with baclofen overdose can initially appear to have serious brain injury, however, full patient recovery can occur in <72 hours. This case provides additional insight into the guidelines for the treatment and management for unknown cause encephalopathy. This case also highlights the link between renal disease, baclofen, and encephalopathy through a review of the literature.
Sections du résumé
BACKGROUND
BACKGROUND
Encephalopathy is reported to have affected 250,000 people in the United States over the last decade, with considerable morbidity and mortality. Baclofen, a gamma-aminobutyric acid-B agonist that acts on the central nervous system, is the drug most widely used to treat spasticity. Baclofen overdose is a potentially deadly condition that can cause encephalopathy and can result from multiple etiologies. Renal disease can contribute to baclofen overdose and encephalopathy, and there are currently no dosing recommendations for patient's on baclofen with renal impairment.
CASE DESCRIPTION
METHODS
We report an unusual case of a man aged 35 years who presented with persistent fevers, seizures, and normal mentation. The patient presented with intrathecal baclofen use and prior exposure to West Nile Virus. He developed acute kidney injury at hospital secondary to vancomycin use, and mental status declined.
CONCLUSIONS
CONCLUSIONS
This case highlights that patients with baclofen overdose can initially appear to have serious brain injury, however, full patient recovery can occur in <72 hours. This case provides additional insight into the guidelines for the treatment and management for unknown cause encephalopathy. This case also highlights the link between renal disease, baclofen, and encephalopathy through a review of the literature.
Identifiants
pubmed: 31954899
pii: S1878-8750(20)30052-8
doi: 10.1016/j.wneu.2020.01.044
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
GABA-B Receptor Agonists
0
Vancomycin
6Q205EH1VU
Meropenem
FV9J3JU8B1
Baclofen
H789N3FKE8
Types de publication
Case Reports
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
136-139Informations de copyright
Copyright © 2020 Elsevier Inc. All rights reserved.