Abstract
This case report is about reversible cardiomyopathy associated with intrathecal baclofen withdrawal. Previous literature has reported that enteral baclofen does not adequately control intrathecal baclofen withdrawal. In our case, coronary atherosclerosis did not play a role in the development of the cardiomyopathy. However, reinstitution of intrathecal baclofen promptly resulted in improvement. One could hypothesize that myocardial stunning from sympathetic hyperactivity led to a similar cardiomyopathy reported with catecholamine excess or acute sympathomimetic poisoning.
Keywords: baclofen withdrawal, cardiomyopathy, intrathecal
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Footnotes
There was no outside funding of any kind used for this study. Poster Presentation at the 2005 North American Congress of Clinical Toxicology Annual Meeting, Orlando, FL.
References
- 1.Mohammed I, Hussain A. Intrathecal baclofen withdrawal syndrome—a life-threatening complication of baclofen pump: A case report. BMC Clin Pharmacol. 2004;4:6–6. doi: 10.1186/1472-6904-4-6. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Wittstein IS, Thiemann DR, Lima JAC, Baughman KL, Schulman SP, Gerstenblith G, Wu KC, Rade JJ, Bivalacqua TJ, Champion HC. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Eng J Med. 2005;352:539–548. doi: 10.1056/NEJMoa043046. [DOI] [PubMed] [Google Scholar]
- 3.Hong R, Matsuyama E, Nur K. Cardiomyopathy associated with the smoking of crystal methamphetamine. JAMA. 1991;265:1152–1154. doi: 10.1001/jama.265.9.1152. [DOI] [PubMed] [Google Scholar]
- 4.Jacobs LJ. Reversible dilated cardiomyopathy induced by methamphetamine. Clin Cardiol. 1989;12:725–727. doi: 10.1002/clc.4960121211. [DOI] [PubMed] [Google Scholar]
- 5.Schifferdecker B, Kodali D, Hausner E, Aragam J. Adrenergic shock — An overlooked clinical entity? Cardiol Rev. 2005;13:69–73. doi: 10.1097/01.crd.0000151679.16187.2f. [DOI] [PubMed] [Google Scholar]
- 6.Stewart MJ, Fraser DM, Boon N. Dilated cardiomyopathy associated with chronic overuse of an adrenaline inhaler. Br Heart J. 1992;68:221–222. doi: 10.1136/hrt.68.8.221. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Haft JI. Cardiovascular injury induced by sympathetic catecholamines. Prog Cardiovasc Dis. 1975;17:73–86. doi: 10.1016/0033-0620(74)90039-5. [DOI] [PubMed] [Google Scholar]
- 8.Carlsson C, Haggendal J. Arterial noradrenaline levels after ethanol withdrawal. Lancet. 1967;290:889–889. doi: 10.1016/S0140-6736(67)92619-0. [DOI] [PubMed] [Google Scholar]
- 9.Greenberg MI, Hendrickson RG. Baclofen withdrawal following removal of an intrathecal baclofen pump despite oral baclofen replacement. J Toxicol Clin Toxicol. 2003;41:83–85. doi: 10.1081/CLT-120018277. [DOI] [PubMed] [Google Scholar]
- 10.Lacy CR, Contrada RJ, Robbins ML, Tannenbaum AK, Moreyra AE, Chelton S, Kostis JB. Coronary vasoconstriction induced by mental stress (simulated public speaking) Am J Cardiol. 1995;75:503–505. doi: 10.1016/S0002-9149(99)80590-6. [DOI] [PubMed] [Google Scholar]
- 11.Handforth CP. Isoproterenol-induced myocardial infarction in animals. Arch Pathol. 1962;73:161–165. [PubMed] [Google Scholar]
- 12.Singal PK, Yates JC, Beamish RE, Dhalla NS. Influence of reducing agents on adrenochrome-induced changes in the heart. Arch Pathol Lab Med. 1981;105:664–669. [PubMed] [Google Scholar]
- 13.Wheatley AM, Thandroyen FT, Opie LH. Catecholamine-induced myocardial cell damage: Catecholamines or adrenochrome. J Mol Cell Cardiol. 1985;17:349–359. doi: 10.1016/S0022-2828(85)80134-6. [DOI] [PubMed] [Google Scholar]
- 14.Fleckenstein A, Frey M, Fleckenstein-Grun G. Consequences of uncontrolled calcium entry and its prevention with calcium antagonists. Eur Heart J. 1983;4(H):43–50. doi: 10.1093/eurheartj/4.suppl_h.43. [DOI] [PubMed] [Google Scholar]