Keywords
Baclofen; CSF sample; ITB therapy; Meningitis; Lumbar puncture
Abstract
Background: Patients with intrathecal baclofen pumps have a known increased risk of meningitis. Optimal antibiotic treatment targets the bacteria found in the Cerebro Spinal Fluid (CSF). However a lumbar puncture in patients with an intrathecal pump may result in damage to the spinal catheter by the needle and treatment failure.
Aims of the study: We report at case of a 32-year-old man with possible meningitis. He had spastic hemiplegia and epilepsy after a head trauma and was treated with baclofen via an intrathecal pump.
Methods: A CSF sample was needed for a specific diagnosis but the location of the spinal catheter hindered a safe lumbar puncture. A search of the current literature did not reveal that special equipment for drawing CSF directly from the pump was available. Therefore the patient was treated with antibiotics according to best practice.
Results: The lack of available literature on the subject and special equipment resulted in a suboptimal diagnosis. As a CSF sample was never obtained targeted antibiotic treatment was not possible.
Conclusion: Preferably the patient should be referred to a specialized hospital where a CSF sample can be drawn directly from the pump. Local hospitals should have the necessary equipment available or a standard procedure for referral to a specialist department for complicated cases. If this is not possible the authors suggest that patients with intrathecal pumps have an x-ray which may visualize the location of the spinal catheter during a lumbar puncture and use a small gauge needle. A post discharge pump checkup is also advised.
Citation
Arndal E. Difficulty in Lumbar Puncture of a Patient With an Intrathecal Baclofen Pump and Possible Meningitis. SM J Case Rep. 2016; 2(4): 1034.