Our first case was a 63-year-old right-handed man who required a permanent intrathecal drug infusion system for intractable nonsurgical back pain in April 2002. The catheter was placed at L1-L2 and was threaded to the T9-T10 level. The patient was successfully treated with hydromorphone and bupivacaine. Slowly escalating pain and a fall preceded a 2-week rapid deterioration in ambulation. Bowel and bladder incontinence developed. The patient had paraparesis with a sensory level at T10. Cerebrospinal fluid examination revealed a mild lymphocytic pleocytosis. Cerebrospinal fluid and catheter tip cultures revealed no growth. Magnetic resonance imaging (MRI) of the spine revealed increased signal and intramedullary enhancement at T9-T10, corresponding to the level of the catheter tip (Figure 1A). Magnetic resonance imaging 6 months later showed resolution of the changes in the thoracic spinal cord (Figure 1B). Two years after the event, the patient was able to walk with assistance devices.
Knox S, Atkinson RP, Stephens R, Coffey RJ, Zusman EE. Myelopathy as a Complication of Intrathecal Drug Infusion Systems. Arch Neurol. 2007;64(2):286–287. doi:10.1001/archneur.64.2.286
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