Cervical sympathetic block to reverse delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage.
OBJECTIVE
The purpose of the present study was to evaluate the feasibility and safety of a locoregional cervical sympathetic block to improve cerebral perfusion in patients suffering from cerebral vasospasm after aneurysmal subarachnoid hemorrhage.


METHODS
Nine consecutive patients with symptoms of delayed ischemic deficits, induced by angiographically confirmed cerebral vasospasm, were treated with the injection of locoregional anesthesia to block the ascending cervical sympathetic chain at the level of the superior cervical ganglion. Neurological status was recorded before and after the procedure, and cerebral angiography was performed before and after the procedure.


RESULTS
No complications occurred in this short series. The procedure appeared to be simple and safe. Horner's signs appeared within 12+/-0.1 minutes and lasted for an average of 6.3+/-4 hours. In all patients, improved cerebral perfusion was detected at the confirmatory angiography but without change in vessel caliber. One patient died of the complications of the initial hemorrhage, and 2 died of the consequences of the severe vasospasm despite maximal medical treatment. In all the other cases, the neurological status promptly returned to normal within 48 hours after the locoregional treatment.


CONCLUSIONS
Patients with mild to moderate symptoms seem to benefit greatly from transient ipsilateral cervical sympathetic block. This simple technique may be helpful when used as an adjunct to the standard therapy to improve cerebral perfusion.
Treggiari
Miriam M
MM
Division of Surgical Intensive Care, Department of Anesthesia, Pharmacology, and Surgical Intensive Care, Geneva University Hospital, Geneva, Switzerland. treggmm@u.washington.edu
Romand
Jacques-André
JA
Martin
Jean-Baptiste
JB
Reverdin
Alain
A
Rüfenacht
Daniel A
DA
de Tribolet
Nicolas
N
D000328:Adult; D000779:Anesthetics, Local; D015901:Angiography, Digital Subtraction; D001340:Autonomic Nerve Block / Q000009:adverse effects; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002045:Bupivacaine; D002533:Cerebral Angiography; D003000:Clonidine; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D017783:Superior Cervical Ganglion / Q000187:drug effects*; D013997:Time Factors; D020301:Vasospasm, Intracranial / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*
D000779:Anesthetics, Local; D003000:Clonidine; D002045:Bupivacaine