513 - Alarmed but Asymptomatic: Electrical Short in an Intrathecal Baclofen Pump

Friday, February 20, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

AE

Alissa Ebenhoeh, MD

Resident - PGY3
Thomas Jefferson University Hospital
PHILADELPHIA, Pennsylvania, United States
KH

Kimberly Heckert, MD

Physician
Jefferson
Philadelphia, Pennsylvania, United States

Co-Author(s)

SH

Spencer H. Haber, BS

Medical Student
Sidney Kimmel Medical College, Thomas Jefferson University
Morristown, New Jersey, United States

Submitter(s)

AE

Alissa Ebenhoeh, MD

Resident - PGY3
Thomas Jefferson University Hospital
PHILADELPHIA, Pennsylvania, United States

Case Diagnosis: A 28-year-old male with spastic quadriplegia from traumatic brain injury managed with a baclofen pump (Medtronic Synchromed II) presented with a critical alarm on the day of discharge from a hospitalization for foreign body ingestion. At presentation, he showed no signs of baclofen withdrawal. Pump interrogation revealed a motor stall without auto-recovery.

Case Description: Thorough investigation revealed no contributing magnet exposure during hospitalization. Despite extensive troubleshooting, the motor remained stalled and pump function could not be restored. A mild increase in spasticity was noted 12 hours after the motor stall, and oral baclofen was initiated to prevent severe withdrawal. Neurosurgery replaced the pump the following day. Subsequent analysis by Medtronic revealed an electrical short secondary to a leak in an outlet port.

Discussions: Pump complications are reported in around 13.1% of patients. Of these complications, only 20.6% (2.7% of all patients) are attributed to hardware issues such as motor stalls. Although rare, pump failure can lead to life-threatening baclofen withdrawal, typically within 4 to 6 hours. Our patient did not exhibit signs of withdrawal until over 12 hours. Notably, his baclofen dose (1100mcg/day) and concentration (3200mcg/mL) were relatively high. We suspect baclofen was still passively entering the intrathecal space via diffusion due to the concentration gradient. Lack of withdrawal symptoms can make it difficult for patients, families, and surgical colleagues to accept the need for urgent pump replacement. Given persistent malfunction despite extensive troubleshooting, the pump was replaced the following day.

Conclusions: In this unusual presentation of baclofen pump failure, minimal withdrawal signs were observed despite an abrupt motor stall in a patient on a relatively high dose. Swift action and relatively high concentration likely prevented a poor outcome. Patient/family education and prompt recognition of pump malfunction are crucial to avoid life-threatening baclofen withdrawal.