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Abstract Details

Reversible Loss of Cortical Responses on SSEP Caused by Baclofen Neurotoxicity
Neuro Trauma and Critical Care
P1 - Poster Session 1 (8:00 AM-9:00 AM)
2-006
Intoxication with baclofen, a selective GABA-B receptor agonist, can produce coma, seizures, and respiratory depression. Brainstem function may be abolished in the most severe cases. However, to our knowledge, transient loss of cortical responses on SSEP has not been previously described.
To report a case of baclofen overdose with favorable recovery despite prolonged coma and transient absence of brainstem reflexes and reversible loss of cortical somatosensory evoked potentials (SSEP). 
NA
A 76 year-old female presented with PEA arrest after baclofen and tramadol overdose. Return of spontaneous circulation was achieved after prolonged resuscitation. In the Emergency Department, she had absent brain stem reflexes with fixed, dilated pupils and no motor response to pain.  Continuous EEG displayed burst-suppression evolving into non-convulsive status epilepticus.  Seizures were controlled with aggressive anti-seizure therapy. SSEP testing on day 3 showed markedly reduced cortical (N20) response on the left and absent response on the right. MRI demonstrated restricted diffusion in bilateral hippocampi and basal ganglia. Repeat SSEP on day 5 showed normal N20 responses bilaterally. Repeat MRI on day 7 showed minimal residual signal changes on FLAIR. By day 11, the patient was following commands. She was discharged on day 30 with mild and improving cognitive deficits.
Baclofen can result in prolonged coma with temporary absence of brainstem reflexes. This case shows that reversible loss of cortical SSEPs is also possible. Prognostication in comatose patients with baclofen overdose should therefore be performed with extreme caution. Serial testing of SSEPs may be advisable in cases in which cortical responses are initially absent. 
Authors/Disclosures
Carmen R. Holmes, MD (Mayo Clinic)
PRESENTER
Dr. Holmes has nothing to disclose.
E. M. Hoffman, DO, PhD (Mayo Clinic, Neurology) Dr. Hoffman has nothing to disclose.
Alejandro A. Rabinstein, MD, FAAN (Mayo Clinic) Dr. Rabinstein has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boston Scientific. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Astra Zeneca. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Shionogi . Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Chiesi. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Brainomix. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurocritical care/NCS-Springer. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Wolters/UptoDate. Dr. Rabinstein has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for EBSCO/DynaMed. Dr. Rabinstein has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for AHA. The institution of Dr. Rabinstein has received research support from Chiesi. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care. Dr. Rabinstein has received publishing royalties from a publication relating to health care.