Baclofen intoxication, once rare, is now increasingly observed in clinical and forensic settings due to its expanding medical and off-label use. However, baclofen is not routinely included in standard postmortem toxicological panels and is usually tested only when explicitly requested. This selective approach, together with the lack of validated cut-offs and standardized interpretative protocols, complicates both clinical management and postmortem evaluation. A systematic review of the literature published between July 2005 and July 2025 was conducted according to PRISMA guidelines, including fatal and non-fatal baclofen intoxications with quantitative toxicological data. Analytical methods, biological matrices, concentration ranges, and clinical outcomes were compared to identify recurring patterns and interpretative gaps. A fatal intrathecal overdose case was also analyzed as a paradigmatic example of diagnostic and methodological challenges. In thirteen studies meeting inclusion criteria and comprising over 300 cases, reported blood concentrations ranged from 0.04 to 110 mg/L, with overlapping values between survivors and fatalities. The analysis revealed marked heterogeneity in matrices and methods, and a poor correlation between concentration and clinical severity, limiting the reliability of toxicological interpretation in both clinical and postmortem settings. Baclofen intoxication illustrates the challenges of interpreting toxicological data without harmonized analytical criteria and highlights the need for standardized procedures and shared reference databases to improve diagnostic and medico-legal accuracy.

The authors report a case of fatal postpartum acute subdural hematoma after multiple attempts at spinal anesthesia related to cesarean delivery. A 22-year-old primigravida was admitted to the Obstetrics and Gynecology Department due to the throes of childbirth. The presence of threatening intrauterine hypoxia indicated a C-section with the usual lumbar anesthesia. However, the anesthesia proved insufficient, necessitating the administration of intratracheal narcosis, which occurred without complication. A healthy, mature boy was born with Apgar scores of 10/1 and 10/5. During the first 8 h of the postpartum period, the primipara exhibited stable vital parameters without neurological symptoms. After 8.5 h, a grand mal seizure was observed following a period of consciousness and spontaneous breathing that soon ceased. The CT scan examination revealed a significant left fronto-temporo-parietal acute subdural hematoma. All brainstem reflexes were absent, lacking corneal, trigemino-facial, and oculo-vestibular reflexes, with submaximal dilated pupils, and unresponsive to direct and consensual light stimuli. Despite an urgent neurosurgery operation and 4 days of intensive therapy, follow-up brain CT examinations showed a massive midline shift and compression of the supratentorial ventricle system. No trauma or other malformations of the brain were detected. According to the primary brain damage protocol, after a 12-hour observation period, brain death was declared, and she was deemed suitable for organ donation. Our mini-review identified 12 published cases of postpartum subdural hematoma following spinal anesthesia between 1995 and 2021. The data highlight the importance of early neuroimaging and multidisciplinary assessment when postpartum headaches or seizures occur.

The development of malignant tumors and their abnormal vasculature can lead to severe changes in tissue perfusion. In this pilot study, we aimed to investigate changes in renal microcirculation and parenchymal abnormalities without treatment and after Vincristine treatment in a rat model of mesenchymal mesoblastic nephroma (Ne/De) tumor cell implantation of rat origin, which closely resembles Wilms' tumor. On the 1st, 4th, and 9th post-operative days, blood samples were collected to test for hematological parameters, erythrocyte deformability, and aggregation. In the Vincristine-treated group the animals received 0.25 mg/kg Vincristine on four occasions. We monitored renal microcirculation, obtained positron emission tomography imaging, and measured the blood flow of the abdominal aorta and the bilateral renal artery and vein. The kidneys were removed for histological analysis at the end of experiment. Leukocyte and platelet count gradually decreased in the Vincristine-treated group during the follow-up period. A significant increase in erythrocyte aggregation was observed after tumor implantation, while this increase was much smaller with Vincristine administration. Erythrocyte deformability deteriorated significantly by day 9th after tumor implantation. In the Tumor-implanted group, we observed structural characteristics of the tumor tissue and a heterogeneous blood flow pattern compared to the contralateral healthy kidney. The tumor growth inhibitory effect of Vincristine was observed. Malignant renal tumors caused significant deterioration and heterogeneity in microcirculation, which may be partly a consequence of abnormal vasculature and partly of deteriorating micro-rheology. The model is similar to Wilms tumor and is suitable for investigating rapid tumorigenesis, tumor vasculature, and therapeutical agents.