Burst Suppression Electroencephalography (EEG) Pattern with Coma and Loss of Brain Stem Reflexes Following a Baclofen Overdose with Subsequent Full Recovery

Patient: Female, 37-year-old Final Diagnosis: Baclofen toxicity Symptoms: Coma Medication:— Clinical Procedure: None Specialty: Neurology OBJECTIVE: Unusual clinical course BACKGROUND: When taken in overdose, baclofen can produce a unique pattern of clinical findings and EEG abnormalities that contrasts to that seen with other sedative hypnotic medications. This includes profound lethargy and coma, loss of basic brainstem reflexes and pupil reactivity, myoclonic jerks and seizures, and a burst suppression pattern on EEG. In the absence of a clear history of ingestion, clinicians may presume the presence of anoxic brain injury and that a progression towards brain death may be imminent. CASE REPORT: We report a case of a middle-aged woman found unresponsive who presented with apnea, loss of rudimentary neurologic findings on physical exam, burst suppression EEG findings, and a prolonged comatose state for nearly 48 h, followed by rapid resolution of symptoms secondary to a supratherapeutic baclofen ingestion. CONCLUSIONS: Baclofen toxicity can present both clinically and with EEG abnormalities consistent with anoxic brain injury, suggesting an inevitable progression to brain death. When provided with appropriate supportive care and prolonged observation, improvement with full neurologic recovery is often seen despite the initial grim clinical picture.