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Stellate ganglion block used to treat reversible cerebral vasoconstriction syndrome.
Reg Anesth Pain Med. 2021 Apr 19 [Online ahead of print]RA

Abstract

BACKGROUND

We 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 REPORT

A 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.

CONCLUSIONS

For 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.

Authors+Show Affiliations

Anesthesiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA jeffrey-s-davis@ouhsc.edu.Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA.Anesthesiology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.Neurology, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33875578

Citation

Davis, Jeffrey, et al. "Stellate Ganglion Block Used to Treat Reversible Cerebral Vasoconstriction Syndrome." Regional Anesthesia and Pain Medicine, 2021.
Davis J, Ozcan MS, Kamdar JK, et al. Stellate ganglion block used to treat reversible cerebral vasoconstriction syndrome. Reg Anesth Pain Med. 2021.
Davis, J., Ozcan, M. S., Kamdar, J. K., & Shoaib, M. (2021). Stellate ganglion block used to treat reversible cerebral vasoconstriction syndrome. Regional Anesthesia and Pain Medicine. https://doi.org/10.1136/rapm-2021-102675
Davis J, et al. Stellate Ganglion Block Used to Treat Reversible Cerebral Vasoconstriction Syndrome. Reg Anesth Pain Med. 2021 Apr 19; PubMed PMID: 33875578.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stellate ganglion block used to treat reversible cerebral vasoconstriction syndrome. AU - Davis,Jeffrey, AU - Ozcan,Mehmet S, AU - Kamdar,Jay K, AU - Shoaib,Maria, Y1 - 2021/04/19/ PY - 2021/03/04/received PY - 2021/03/31/revised PY - 2021/04/02/accepted PY - 2021/4/20/entrez PY - 2021/4/21/pubmed PY - 2021/4/21/medline KW - autonomic nerve block KW - neurologic manifestations KW - regional anesthesia KW - treatment outcome JF - Regional anesthesia and pain medicine JO - Reg Anesth Pain Med N2 - BACKGROUND: We 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 REPORT: A 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. CONCLUSIONS: For 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. SN - 1532-8651 UR - https://www.unboundmedicine.com/medline/citation/33875578/Stellate_ganglion_block_used_to_treat_reversible_cerebral_vasoconstriction_syndrome. L2 - https://rapm.bmj.com/lookup/pmidlookup?view=long&pmid=33875578 DB - PRIME DP - Unbound Medicine ER -
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