Using intrathecal baclofen for effective management of paroxysmal sympathetic hyperactivity secondary to cerebral fat emboli syndrome: a case report

BACKGROUND: High energy impacts, such as motor vehicle accidents, may present with cooccurring long bone fractures and traumatic brain injuries. Cerebral fat emboli syndrome (FES) is one complication of long bone fractures which, in severe cases, may result in paroxysmal sympathetic hyperactivity (PSH). CASE DESCRIPTION: This case report presents a patient with treatment refractory PSH which persisted more than six months after initial injury when he first presented to an outpatient physiatry clinic. His clinical presentation at that time included spasticity, dystonia, diaphoresis, and tachycardia despite attempts at managing PSH with five different oral medications. An intrathecal baclofen trial was recommended which demonstrated significant improvement in PSH manifestations and an intrathecal pump was implanted as a result. Within three months following intrathecal baclofen pump placement, all oral medications for PSH were discontinued. DISCUSSION/CONCLUSION: To our knowledge, this is the first report of successful treatment of treatment refractory PSH secondary to cerebral fat emboli syndrome successfully treated with intrathecal baclofen. Early initiation of ITB in such instances can improve functional outcomes, decrease risk of polypharmacy, and reduce caregiver burden.