Article

We describe two patients in whom serious bradycardia and arterial hypotension
occurred after a small intrathecal baclofen (ITB) test bolus.
Both patients
suffered from severe spasticity (one due to brain injury, one due to spinal cord
injury). Medical history and diagnostic examinations revealed no previous cardiological problems. Ten minutes following a 50 mug ITB bolus, patient 1
developed bradycardia (58 bpm) and incomplete right branch block, lasting for 3
hours. In patient 2, a 20 mug ITB bolus was followed after 5 minutes by severe
bradycardia (30 bpm) and hypotension (60/30 mmHg), without loss of consciousness,
lasting for 10 minutes. Exaggerated muscle tone was alleviated in both patients
after 2 hours by the applied doses. Neither patient underwent implantation of a
permanent pump system, both were continued on oral baclofen. Despite numerous
unremarkable repeat cardiological exams, both patients suffered fatal cardiac
arrest one and two months later, respectively. Our observations suggest that ITB
may herald cardiovascular dysfunction in predisposed patients. Careful
cardiological examination before ITB treatment, and close monitoring during ITB
testing in particular, is advised.

Langue : ANGLAIS