Stellate ganglion block used to treat reversible cerebral vasoconstriction syndrome

Stellate ganglion block used to treat reversible cerebral vasoconstriction syndrome

BackgroundWe present a case report of a patient who developed severe reversible cerebral vasoconstriction syndrome, which was worsening despite typical interventional and supportive care. We administered a stellate ganglion block (SGB) and monitored the vasospasm with transcranial Doppler measuremen...

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Bibliographic Details
Published in:Regional anesthesia and pain medicine Vol. 46; no. 8; pp. 732 - 734
Main Authors: Davis, Jeffrey, Ozcan, Mehmet S, Kamdar, Jay K, Shoaib, Maria
Format: Journal Article
Language:English
Published: England BMJ Publishing Group Ltd 01-08-2021
BMJ Publishing Group LTD
Subjects:
autonomic nerve block
Carotid arteries
Case report
Case reports
Flow velocity
Headaches
Hemorrhage
Medical imaging
Nervous system
neurologic manifestations
Patients
Physiology
Regional anesthesia
treatment outcome
Ultrasonic imaging
Veins & arteries
United States > US
Oklahoma
autonomic nerve block
neurologic manifestations
treatment outcome
regional anesthesia
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Summary:BackgroundWe present a case report of a patient who developed severe reversible cerebral vasoconstriction syndrome, which was worsening despite typical interventional and supportive care. We administered a stellate ganglion block (SGB) and monitored the vasospasm with transcranial Doppler measurements.Case reportA 25-year-old woman was admitted with recurrent headaches and neurological symptoms, which angiography showed to be caused by diffuse, multifocal, segmental narrowing of the cerebral arteries leading to severe ischemia in multiple regions. Typical treatment was initiated with arterial verapamil followed by supportive critical care, including nimodipine, intravenous fluids, permissive hypertension, and analgesia. Vasospasm was monitored daily via transcranial Doppler ultrasound (TCD). After symptoms and monitoring suggested worsening vasospasm, an SGB was administered under ultrasound guidance. Block success was confirmed via pupillometry, and repeat TCD showed improved flow through the cerebral vasculature. Improvement in vascular flow was accompanied by a gradual reduction in acute neurological symptoms, with the patient reporting no headaches the following morning.ConclusionsFor patients with reversible cerebral vasoconstriction syndrome who develop severe signs or symptoms despite typical treatment, sympathetic blockade may be a possible rescue therapy. This may extend to other causes of severe vasospasm as well, and further study is needed to determine if the SGB should be included in routine or rescue therapy.
Bibliography:ObjectType-Case Study-2
SourceType-Scholarly Journals-1
ObjectType-Feature-4
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ISSN:1098-7339
1532-8651
DOI:10.1136/rapm-2021-102675