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
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U2 - 10.1007/s00701-019-03994-2
DO - 10.1007/s00701-019-03994-2
M3 - Article
AN - SCOPUS:85068805711
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
ER -