Case 4 History

Presented by: Dr. Kris Kumar, MB, MS, FRCSC, FACS, SOM
Age: 64
Sex: Male

History:
  • December 2000 -- Large infarct of the left temporal parietal region which extends towards the internal capsule. Following this he developed a thalamic pain syndrome. He is R hemiparetic and dysphasic.
  • September 2002 -- deep brain implant of the sensory thalamus which he responded well to initially. Six weeks later the benefits could not be maintained in spite of repeated adjustments of stimulation parameters.
  • April 2003 -- After a very successful baclofen trial a syncromed pump was implanted, infusion of 50ug/day. The dose gradually increased to 300ug/day (periodic bolusing 25ug/q2h) while methadone gradually tapered down.
  • July 2003 -- Pain control decreased. Pumpogram done showing cyst catheter tip.
    •

    Pumpogram showing cyst at catheter tip

    • September 2003 -- IT catheter was pulled down and away from the cyst and secured in place. Infusion was restarted at 120ug/day (240ug/q4h) and gradually titrated up to 240ug/day (40ug/q4h).
    • October 2003 -- Pain from stroke and spasticity is much improved and dose of methadone has been reduced. Now the patient is c/o new pain in low/mid back and down right leg.

    October 27, 2003 images

    Produced by Medi-Fax Communications
    Last Updated: November 2, 2003
    ©2003 Medi-Fax Communications
    Fax: (306) 352-0499