Journal of Medical Toxicology

, Volume 3, Issue 4, pp 187–189 | Cite as

Reversible cardiomyopathy complicating intrathecal baclofen withdrawal: A case report

Toxicology Observations

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 

References

  1. 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.PubMedCrossRefGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. 3.
    Hong R, Matsuyama E, Nur K. Cardiomyopathy associated with the smoking of crystal methamphetamine.JAMA. 1991;265:1152–1154.PubMedCrossRefGoogle Scholar
  4. 4.
    Jacobs LJ. Reversible dilated cardiomyopathy induced by methamphetamine.Clin Cardiol. 1989;12:725–727.PubMedCrossRefGoogle Scholar
  5. 5.
    Schifferdecker B, Kodali D, Hausner E, Aragam J. Adrenergic shock — An overlooked clinical entity?Cardiol Rev. 2005;13: 69–73.PubMedCrossRefGoogle Scholar
  6. 6.
    Stewart MJ, Fraser DM, Boon N. Dilated cardiomyopathy associated with chronic overuse of an adrenaline inhaler.Br Heart J 1992;68:221–222.PubMedCrossRefGoogle Scholar
  7. 7.
    Haft JI. Cardiovascular injury induced by sympathetic catecholamines.Prog Cardiovasc Dis. 1975;17:73–86.CrossRefGoogle Scholar
  8. 8.
    Carlsson C, Haggendal J. Arterial noradrenaline levels after ethanol withdrawal.Lancet. 1967;290:889.CrossRefGoogle Scholar
  9. 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.PubMedCrossRefGoogle Scholar
  10. 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.PubMedCrossRefGoogle Scholar
  11. 11.
    Handforth CP. Isoproterenol-induced myocardial infarction in animals.Arch Pathol. 1962;73:161–165.PubMedGoogle Scholar
  12. 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.PubMedGoogle Scholar
  13. 13.
    Wheatley AM, Thandroyen FT, Opie LH. Catecholamine-induced myocardial cell damage: Catecholamines or adrenochrome.J Mol Cell Cardiol. 1985;17:349–359.PubMedCrossRefGoogle Scholar
  14. 14.
    Fleckenstein A, Frey M, Fleckenstein-Grun G. Consequences of uncontrolled calcium entry and its prevention with calcium antagonists.Eur Heart J. 1983;4 suppl H:43–50.PubMedGoogle Scholar

Copyright information

© American College of Medical Toxicology 2007

Authors and Affiliations

  1. 1.Division of Medical ToxicologyUPMC PresbyterianPittsburgh
  2. 2.Department of Medical ToxicologyBanner Good Samaritan Medical CenterPhoenix

Personalised recommendations