Late recovery of responsiveness after intra-thecal baclofen pump implantation and the role of diffuse pain and severe spasticity: a case report

Rita Formisano, Marta Aloisi, Marianna Contrada, Francesca Spanedda, Sara Schiattone, Sylwia Niedbala, Maria Rosaria Cobianchi, Gianni Colini Baldeschi, Maria Gabriella Buzzi

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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 languageEnglish
JournalActa Neurochirurgica
DOIs
Publication statusPublished - 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

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