Transient alteration of consciousness in spinal cord injury secondary to Baclofen use: a case report

Spinal Cord Series and Cases, 2022 · DOI: https://doi.org/10.1038/s41394-022-00511-z · Published: April 7, 2022

Spinal Cord Injury Pharmacology Rehabilitation

Simple Explanation

Baclofen, a common medication for spasticity, can cause transient alterations of consciousness, which can be mistaken for orthostatic hypotension in spinal cord injury (SCI) patients. A patient with SCI experienced confusion after baclofen dosage increase, which resolved upon discontinuation, suggesting baclofen as the cause. Clinicians should consider baclofen's side effects, especially in patients with acute kidney injury (AKI) and neurogenic bladders, and taper baclofen if adverse effects are suspected, watching for withdrawal signs.

Study Duration

Not specified

Participants

A 43-year-old man with an acute SCI

Evidence Level

Level 4; Case Report

Key Findings

1
Baclofen can cause transient alterations of consciousness in SCI patients, mimicking orthostatic hypotension.
2
Acute kidney injury increases the risk of baclofen toxicity.
3
Baclofen withdrawal can be life-threatening and requires careful tapering.

Research Summary

This case report highlights an instance of transient alterations in consciousness in a 43-year-old male with spinal cord injury following baclofen initiation, which resolved upon baclofen discontinuation. The patient's history included aortic dissection, paraplegia, acute kidney injury, and baclofen use for spasticity; episodes of confusion and lightheadedness occurred post-baclofen initiation. The report emphasizes the importance of considering baclofen toxicity in the differential diagnosis for altered mental status in SCI patients, especially those with AKI, and highlights the risks associated with abrupt baclofen discontinuation.

Practical Implications

Awareness of Baclofen Side Effects

Clinicians should be aware of the uncommon adverse effects of baclofen, particularly in SCI patients with AKI and neurogenic bladders.

Careful Baclofen Management

Baclofen should be tapered if side effects are suspected, and abrupt discontinuation should be avoided to prevent life-threatening withdrawal.

Differential Diagnosis Consideration

Baclofen toxicity should be included in the differential diagnosis for altered mental status in SCI patients.

Study Limitations

1
Single case report limits generalizability
2
Patient had multiple comorbidities, making it difficult to isolate baclofen as the sole cause
3
Lack of continuous monitoring during episodes of altered consciousness

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