title: Percutaneous Cervical Sympathetic Block for Pain Control after Internal Carotid Artery Dissection. A Report of Two Cases.
abstract: BACKGROUND
  Medical treatment of cranio-cervical pain can be suboptimal in patients with internal carotid artery (ICA) dissection. We report the use of cervical sympathetic block for treatment of pain in two patients with ICA dissection.
  
  
  METHODS
  A 58-year-old man and a 43-year-old woman presented with severe cranio-cervical pain associated with left and right ICA dissection confirmed by magnetic resonance imaging and cerebral angiography. Due to suboptimal control of pain with medical treatment, cervical sympathetic block was performed under fluoroscopic guidance using 20 ml of bupivacaine injected lateral to the posterior aspect of sixth vertebral body in both patients. On self-reported pain scale, the 58-year-old man reported improvement in pain intensity from 8/10 pain to 0/10 within 1 h of blockade. The patient remained relatively pain free for the 24-h post blockade. Mild recurrence of pain was noted on Day 2. The 43-year-old woman reported improvement in pain intensity from 6/10 pain to 0/10 within 1 h of blockade. The patient remained pain free for five days with recurrence to previous intensity.
  
  
  CONCLUSIONS
  Cervical sympathetic blockade in patients with ICA dissection may be an effective option in the event of suboptimal pain control with medical treatment; however, the technique may be limited due to relatively short duration of action.
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, MN 56303, USA.
authors.forename: Omar
authors.initials: O
authors.lastname: Saeed
authors.affiliation: University of Illinois College of Medicine, Rockford, IL 60612, USA.
authors.forename: Asif A
authors.initials: AA
authors.lastname: Khan
authors.affiliation: University of California, San Diego, La Jolla, CA 92093, USA.
authors.forename: Nabeel A
authors.initials: NA
authors.lastname: Herial
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, MN 56303, USA.
authors.forename: Emrah
authors.initials: E
authors.lastname: Aytac
authors.affiliation: Zeenat Qureshi Stroke Institute, St. Cloud, MN 56303, USA.
authors.forename: Adnan I
authors.initials: AI
authors.lastname: Qureshi
keywords: Horner’s syndrome; Internal carotid artery (ICA); cervical sympathetic block; dissection; headache; neck pain; sympathetic pain