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.
| Original language | English |
|---|---|
| Journal | Acta Neurochirurgica |
| DOIs | |
| Publication status | Published - Jan 1 2019 |
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Keywords
- Behavioral responsiveness
- Coma recovery scale-revised
- Disorder of consciousness
- Functional locked-in
- Intra-thecal baclofen
- Niciception coma scale
- Pain
- Spasticity
ASJC Scopus subject areas
- Surgery
- Clinical Neurology
Cite this
Late recovery of responsiveness after intra-thecal baclofen pump implantation and the role of diffuse pain and severe spasticity : a case report. / Formisano, Rita; Aloisi, Marta; Contrada, Marianna; Spanedda, Francesca; Schiattone, Sara; Niedbala, Sylwia; Cobianchi, Maria Rosaria; Baldeschi, Gianni Colini; Buzzi, Maria Gabriella.
In: Acta Neurochirurgica, 01.01.2019.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Late recovery of responsiveness after intra-thecal baclofen pump implantation and the role of diffuse pain and severe spasticity
T2 - a case report
AU - Formisano, Rita
AU - Aloisi, Marta
AU - Contrada, Marianna
AU - Spanedda, Francesca
AU - Schiattone, Sara
AU - Niedbala, Sylwia
AU - Cobianchi, Maria Rosaria
AU - Baldeschi, Gianni Colini
AU - Buzzi, Maria Gabriella
PY - 2019/1/1
Y1 - 2019/1/1
N2 - 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.
AB - 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.
KW - Behavioral responsiveness
KW - Coma recovery scale-revised
KW - Disorder of consciousness
KW - Functional locked-in
KW - Intra-thecal baclofen
KW - Niciception coma scale
KW - Pain
KW - Spasticity
UR - http://www.scopus.com/inward/record.url?scp=85068805711&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85068805711&partnerID=8YFLogxK
U2 - 10.1007/s00701-019-03994-2
DO - 10.1007/s00701-019-03994-2
M3 - Article
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
ER -