earticle

영어

Intrathecal morphine pump (IT-pump) has been known as an effective treatment of chronic cancer pain. There are some complications of IT-pump implantation such as wound infection, cerebrospinal fluid (CSF) leakage causing intracranial hypotension, catheter-related problems, but uncommon. We report the case of 65-year-old male with bladder cancer. The patient had no underlying disease other than receiving conservative treatment for chronic headache of unknown cause 7 years ago. IT-pump was implanted due to pain in the left lower extremity and low back that did not resolve even with high doses of opioid analgesics. Headache occurred on the 1st day after the procedure, but with conservative treatment, the headache disappeared on the 2nd day but there was only mild neck stiffness. At 2 weeks after the procedure, severe headache and altered mentality were seen, and chronic subdural hemorrhage (SDH) was confirmed bilaterally on the non-contrast computed tomography scan of brain. After Burr hole trephination, the patient's symptoms improved. After one month, the patient no longer complained of headache. In addition, pain in the left lower extremity was alleviated, reducing the need for opioid analgesics and not affecting daily life. SDH is a complication that must be considered in patients who have undergone IT-pump implantation because it can cause neurological problems. SDH is known to be caused by CSF leak. A better prognosis can be expected if the patient complains of symptoms and is identified early and appropriately treated.