One of the most dangerous and distressing complications of subarachnoid hemorrhage is the development of delayed cerebral ischemia from cerebral vasospasm. Although the exact mechanism causing cerebral vasospasm remains unclear, current evidence suggests that breakdown products of blood within the subarachnoid space may interact with the sympathetic innervation of the cerebral vasculature to produce vasoconstriction. Therefore, a novel treatment that would lessen these sympathetic effects may be beneficial to patients with cerebral vasospasm. This review will examine the potential benefit to neuro-critical care medicine that ultrasound-guided cervical sympathetic blockade, also known as the stellate ganglion block, could have on cerebral vasospasm.
ClaassenJBernardiniGLKreiterK. Effect of cisternal and ventricular blood on risk of delayed cerebral ischemia after subarachnoid hemorrhage: the Fisher scale revisited. Stroke. 2001;32:2012-2020.
2.
PasqualinA. Epidemiology and pathophysiology of cerebral vasospasm following subarachnoid hemorrhage. J Neurosurg Sci. 1998;42:15-21.
3.
de RooijNKLinnFHvan der PlasJAAlgraARinkelGJ. Incidence of subarachnoid haemorrhage: a systematic review with emphasis on region, age, gender and time trends. J Neurol Neurosurg Psychiatry. 2007;78:1365-1372.
4.
FeiginVLRinkelGJLawesCM. Risk factors for subarachnoid hemorrhage: an updated systematic review of epidemiological studies. Stroke. 2005;36:2773-2780.
5.
SuarezJITarrRWSelmanWR. Aneurysmal subarachnoid hemorrhage. N Engl J Med. 2006;354:387-396.
6.
BillerJGoderskyJCAdams HP Jr. Management of aneurysmal subarachnoid hemorrhage. Stroke. 1988;19:1300-1305.
7.
MolyneuxAJKerrRSYuLM. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion. Lancet. 2005;366:809-817.
8.
SimmRFde AguiarPHde Oliveira LimaMPaivaBL. Transcranial Doppler as a routine in the treatment of vasospasm following subarachanoid hemorrhage (SAH). Acta Neurochir Suppl. 2013;115:75-76.
RubenJEMayerRA. Is stellate ganglion block of value in stroke?JAMA. 1953;153:1002-1004.
11.
HarmelMHHafkenschielJHAustinGMCrumptonCWKetySS. The effect of bilateral stellate ganglion block on the cerebral circulation in normotensive and hypertensive patients. J Clin Invest. 1949;28:415-418.
12.
PallinIMDeutschEV. Death following stellate ganglion block. Ann Surg. 1951;133:226-233.
13.
TreggiariMMRomandJAMartinJBReverdinARufenachtDAde TriboletN. Cervical sympathetic block to reverse delayed ischemic neurological deficits after aneurysmal subarachnoid hemorrhage. Stroke. 2003;34:961-967.
14.
GuptaMMBithalPKDashHHChaturvediAMahajanRP. Effects of stellate ganglion block on cerebral haemodynamics as assessed by transcranial Doppler ultrasonography. Br J Anaesth. 2005;95:669-673.
15.
JainVRathGPDashHHBithalPKChouhanRSSuriA. Stellate ganglion block for treatment of cerebral vasospasm in patients with aneurysmal subarachnoid hemorrhage—a preliminary study. J Anaesthesiol Clin Pharmacol. 2011;27:516-521.
16.
NarouzeS. Atlas of Ultrasound-Guided Procedures in Interventional Pain Management. 1st ed. New York, NY: Springer, 2010.
17.
EliasM. Cervical sympathetic and stellate ganglion blocks. Pain Physician. 2000;3:294-304.
18.
GofeldMBhatiaAAbbasSGanapathySJohnsonM. Development and validation of a new technique for ultrasound-guided stellate ganglion block. Reg Anesth Pain Med. 2009;34:475-479.
19.
SongJGHwangGSLeeEH. Effects of bilateral stellate ganglion block on autonomic cardiovascular regulation. Circ J. 2009;73:1909-1913.
20.
SolenskiNJHaleyECJrKassellNF. Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study. Crit Care Med. 1995;23:1007-1017.
