Case 9 History ---- The patient was a 16-year-old male with a medical history significant for prematurity with intraventricular hemorrhage, seizure disorder, and cerebral palsy who underwent post spinal fusion surgery (T3 to sacrum) on 12/5 for scoliosis. The post-surgical course was complicated by fever and significant pain issues. Though the patient’s chest x-rays and cultures were negative, antibiotics were presumptively started during his stay and white blood cell count declined from 15,000 to 10,800. The patient was discharged on 12/20, but returned four days later with complaints of ongoing pain. In the ER he was tachypneic, desaturating, and displaying increased spasticity. Imaging suggested discontinuity of the patient’s Baclofen pump at the level of insertion into the subarachnoid space. The decision was made to take the patient to the operating room for repair. During surgery, the exact point of discontinuity could not be ascertained. The old catheter was removed and replaced with a new system. Thereafter, while completing tunneling of a drain, the patient went into cardiopulmonary arrest. Despite efforts to resuscitate he expired on 12/24. ---- At autopsy he had remote cortical neuronal loss in a ulegyric pattern, white matter axon and myelin loss with marked atrophy, preferentially involving the periventricular areas, remote perivascular calcifications and granular ependymitis.
