Intra-thecal baclofen pump has been proven a safe and effective treatment of spasticity. Subdural hematoma has been rarely described following intra-thecal drug delivery device insertion. We report on the rare case of a 45-year-old male with multiple sclerosis who presented with symptoms of intra-cranial hypotension 1 month after insertion of an intra-thecal baclofen pump for severe spasticity. Non-contrast head computerized tomography scan revealed bilateral, sub-acute, subdural hematomas. Due to the nature of the patient’s symptoms suggesting intra-cranial hypotension, surgical repair of the cerebrospinal fluid leak only was initially performed. However, after an initial improvement, the patient experienced increasing in severity headache and worsening tetraparesis. Subsequently, the patient underwent burr hole evacuation of the subdural hematomas with improvement of his symptoms. On the 6-week follow-up, he reported no headache and he was able to walk with assistance. Subdural hematomas should be considered in all patients presenting with new neurologic deficits or persistent headache following intra-thecal drug delivery device insertion. Early recognition and appropriate management of this rare but potentially life-threatening complication is of great importance to improve prognosis and patient outcomes.

中文翻译：

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鞘内注射巴氯芬泵后双侧亚急性硬脑膜下血肿：病例报告及文献复习

鞘内注射巴氯芬已被证明是安全有效的痉挛治疗方法。鞘内注射药物后插入硬膜下血肿很少。我们报道了一个罕见的病例，该病例为一例45岁男性多发性硬化症，在鞘内注射巴氯芬泵引起严重痉挛后1个月出现颅内低血压症状。非对比头计算机断层扫描显示双侧，亚急性，硬膜下血肿。由于患者症状的性质表明颅内低血压，最初仅对脑脊液漏进行手术修复。但是，在最初的改善之后，患者的头痛加剧，四肢瘫痪恶化。后来，患者接受了硬膜下血肿的毛刺孔疏散，症状得到改善。在为期6周的随访中，他没有头痛，并且能够在协助下行走。在鞘内给药装置插入后出现新的神经功能缺损或持续头痛的所有患者均应考虑硬膜下血肿。对这种罕见的但可能危及生命的并发症进行早期识别和适当管理，对于改善预后和患者预后至关重要。