SHM Converge Scientific Abstract ePoster Gallery-Brain Death? Or Baclofen

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This case describes a 42-year-old man with schizoaffective disorder and polysubstance abuse who was found unconscious on the floor of his apartment with significant facial bleeding. He had recently filled prescriptions including fluphenazine, olanzapine, clozapine, benztropine, and baclofen. On arrival, he was intubated for airway protection and appeared profoundly unresponsive, with a Glasgow Coma Scale of 3, fixed nonreactive pupils, absent brainstem reflexes, flaccid limbs, and intermittent generalized myoclonic jerks.<br /><br />Initial workup showed no structural cause for coma: CT head, CT spine, MRI brain, and echocardiogram were unremarkable aside from a nasal fracture. Lumbar puncture was normal and cultures were negative. Toxicology was notable for meth/amphetamine and alcohol level of 82. EEG demonstrated a burst-suppression/isoelectric pattern consistent with severe cerebral dysfunction, and he later developed a generalized tonic-clonic seizure during monitoring.<br /><br />A serum baclofen level obtained on admission was markedly toxic at 10 mcg/ml (reference 0.08–0.6 mcg/ml), supporting baclofen overdose as the cause of his apparent “brain death” presentation. The report emphasizes that baclofen toxicity can produce coma, respiratory depression, loss of reflexes, autonomic instability, seizures, and even EEG patterns that mimic devastating anoxic brain injury. However, unlike true brain death, this pattern may be reversible.<br /><br />The patient gradually recovered over time, with return of neurological function and eventual recovery to baseline. Serial EEG changes paralleled his clinical improvement, indicating recovering cortical activity. This case highlights the importance of considering baclofen toxicity in profoundly comatose patients with absent reflexes and burst-suppression EEG, especially when imaging is negative and there is a history of access to baclofen.

Asset Subtitle

Joshua T. Haywood

Meta Tag

Author List Joshua T. Haywood, Samer Hasson

Category Clinical Vignettes

Concept Baclofen Toxicity

Concept Coma

Concept Burst-Suppression Pattern

Concept Isoelectric Background

Concept Brain Death

Distinguished Non-Finalist

Presenter Organization Verde Valley Medical Center Internal Medicine Residency Program

Presenting Author Joshua T. Haywood

Track Adult

Keywords

baclofen overdose

coma

brain death mimic

burst-suppression EEG

seizure

toxicology

respiratory depression

schizoaffective disorder

polysubstance abuse

neurological recovery

Baclofen Toxicity

Coma

Burst-Suppression Pattern

Isoelectric Background

Brain Death