Massive baclofen overdose.

A case is presented of a massive baclofen overdose with the highest blood baclofen concentrations currently reported. Interesting clinical features included profound hypotension, distributive shock and absent brainstem reflexes. Cerebral recovery was surprisingly slow but complete, and was then unexpectedly terminated by a sudden major splenic arterial haemorrhage followed by a severe haemorrhage of the aorta which proved to be due to cystic medial necrosis. This arterial anatomic abnormality and cause of death may have been coincidental, or may instead be a previously unreported complication of massive baclofen toxicity.