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首页> 外文期刊>Annals of physical and rehabilitation medicine >Takotsubo cardiomyopathy as a reversible complication of intrathecal baclofen withdrawal
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Takotsubo cardiomyopathy as a reversible complication of intrathecal baclofen withdrawal

机译：Takotsubo 心肌病作为鞘内巴氯芬戒断的可逆并发症

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Intrathecal baclofen (ITB) infusion is a common treatment for patients with diffuse lower-limb and truncal spasticity after central nervous system injury (spinal cord or traumatic brain injury, stroke, multiple sclerosis and cerebral palsy). An acute treatment disruption, caused by a pump or catheter dysfunction, can cause a withdrawal syndrome. Clinical features of baclofen withdrawal syndrome (BWS) are well described, and the severity can range from pruritus and delirium to multi-system organ failure leading to death. Severe manifestations of BWS such as reversible cardiomyopathy and cardiac arrest have been described, with few clues as to the pathophysiology. Nonetheless, we report the first case of a specific, reversible acute cardiac failure, Takotsubo syndrome (TTS), which gives insights into the putative mechanisms of acute cardiac failure in BWS. A 55-year-old man, regularly followed for posttraumatic complete thoracic level 2 (Th2) paraplegia (American Spinal Injury Association Impairment Scale-A), underwent surgery to replace an end-of-life intrathecal baclofen pump (Medtronic, Dublin, Ireland). He was admitted to our physical medicine and rehabilitation department 1 month later for progressive diffuse supralesional pruritus that had started 2 days before, general discomfort, and sublesional spasms in the lower limbs for the last 24 h, which highly suggested BWS. Abdominal radiography revealed that the distal extremity of the catheter had moved out of the intrathecal space (Fig. 1A).
机译：鞘内注射巴氯芬 （ITB） 是中枢神经系统损伤（脊髓或创伤性脑损伤、中风、多发性硬化症和脑瘫）后弥漫性下肢和躯干痉挛患者的常用治疗方法。由泵或导管功能障碍引起的急性治疗中断可导致戒断综合征。巴氯芬戒断综合征 （BWS） 的临床特征已得到充分描述，其严重程度从瘙痒和谵妄到导致死亡的多系统器官衰竭不等。已经描述了 BWS 的严重表现，例如可逆性心肌病和心脏骤停，但关于病理生理学的线索很少。尽管如此，我们报告了第一例特定的、可逆的急性心力衰竭病例，Takotsubo综合征（TTS），这为BWS中急性心力衰竭的推定机制提供了见解。一名 55 岁男性因创伤后完全胸腔 2 级 （Th2） 截瘫（美国脊髓损伤协会损伤量表 A）定期随访，接受了更换临终鞘内巴氯芬泵的手术（美敦力，都柏林，爱尔兰）。1 个月后，他因 2 天前开始的进行性弥漫性病灶上瘙痒、全身不适和过去 24 小时内下肢病灶下痉挛而住进我们的物理医学和康复科，这高度提示 BWS。腹部X线检查显示导管远端已移出鞘内腔（图1A）。

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