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- Title
Late recovery of responsiveness after intra-thecal baclofen pump implantation and the role of diffuse pain and severe spasticity: a case report.
- Authors
Formisano, Rita; Aloisi, Marta; Contrada, Marianna; Spanedda, Francesca; Schiattone, Sara; Niedbala, Sylwia; Cobianchi, Maria Rosaria; Baldeschi, Gianni Colini; Buzzi, Maria Gabriella
- 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.
- Subjects
SPASTICITY; DECOMPRESSIVE craniectomy; PAIN; COMA; PUMPING machinery; WAKEFULNESS
- Publication
Acta Neurochirurgica, 2019, Vol 161, Issue 9, p1965
- ISSN
0001-6268
- Publication type
Article
- DOI
10.1007/s00701-019-03994-2