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Images in Neurology |

Myelopathy as a Complication of Intrathecal Drug Infusion Systems

Stephen Knox, MD; Richard P. Atkinson, MD; Roger Stephens, MD, PhD; Robert J. Coffey, MD; Edie E. Zusman, MD
Arch Neurol. 2007;64(2):286-287. doi:10.1001/archneur.64.2.286.
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Our first case was a 63-year-old right-handed man who required a permanent intrathecal drug infusion system for intractable nonsurgical back pain in April 2002. The catheter was placed at L1-L2 and was threaded to the T9-T10 level. The patient was successfully treated with hydromorphone and bupivacaine. Slowly escalating pain and a fall preceded a 2-week rapid deterioration in ambulation. Bowel and bladder incontinence developed. The patient had paraparesis with a sensory level at T10. Cerebrospinal fluid examination revealed a mild lymphocytic pleocytosis. Cerebrospinal fluid and catheter tip cultures revealed no growth. Magnetic resonance imaging (MRI) of the spine revealed increased signal and intramedullary enhancement at T9-T10, corresponding to the level of the catheter tip (Figure 1A). Magnetic resonance imaging 6 months later showed resolution of the changes in the thoracic spinal cord (Figure 1B). Two years after the event, the patient was able to walk with assistance devices.

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Figure 1.

A, Sagittal T1-weighted postcontrast image of the thoracic spine obtained at presentation showing intramedullary enhancing lesion with central nonenhancing component (arrow). B, Sagittal T1-weighted postcontrast image obtained 6 months later showing resolution of the enhancing thoracic spinal cord mass seen at presentation (arrow).

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