A 29-year-old female patient was admitted to the neurointensive care unit subsequent to a motor vehicle accident resulting in extensive polytrauma and traumatic brain injury necessitating decompressive craniectomy. During her hospitalization, she experienced occasional episodes of tachycardia, which were attributed to pain and the response to opioid tapering. She was discharged three months later with plans for elective cranioplasty. However, she returned a month thereafter with hydrocephalus and hygroma, stemming from the decompressive craniectomy. A ventriculoperitoneal derivation catheter was subsequently inserted. Shortly thereafter, she presented with paroxysmal tachycardia, tachypnea, hypertension, hyperthermia, hypertonia, and sweating. Multiple paroxysmal episodes occurred throughout the day. Treatment involving propranolol, gabapentin, clonidine, dexmedetomidine, opioids, and enteral baclofen yielded limited clinical improvement. Consequently, an intrathecal baclofen pump in a continuous infusion of 275 mcg per day was implanted as a means of symptom control, particularly targeting the hypertonia. This intervention led to a notable improvement, enabling a reduction in enteral drug administration.

Our experience underscores the potential efficacy of intrathecal baclofen as an option for refractory cases of paroxysmal sympathetic hyperactivity.