Profound Bradycardia After Intrathecal Baclofen Injection in a Patient With Hydranencephaly

BACKGROUND: Intrathecal baclofen is often used to treat medically intractable spasticity of cerebral or spinal origin. Complications are rare but close monitoring is routinely performed with intrathecal test doses and before pump implantation. METHODS: We describe a 6 year-old girl with hydranencephaly who underwent an intrathecal baclofen test dose and developed severe bradycardia. RESULTS: A 6 year-old girl with hydranencephaly, quadriplegic cerebral palsy, and severe spasticiityn was a candidate for an intrathecal baclofen pump. She underwent an intrathecal baclofen test dose and within 4 hours developed a heart rate between 30-40 beats per minute and mild hypotension without neurological side effects. Vitals signs subsequently normalized, and she was discharged home within 48 hours of admission. CONCLUSIONS: Although neurological side effects such as drowsiness and weakness are commonly associated with intrathecal baclofen test doses, attention should also be focused on possible hemodynamic complications including significant bradycardia, especially in vulnerable patients such as those with possible or known hypothalamic dysfunction.