Bilateral Stellate Ganglion Block After Ventricular Arrhythmia May Hide Clinical Signs of the Cushing Triad: A Case Study and Review of the Literature.

BACKGROUND

Stellate ganglion blockade (SGB) has been described as a rescue therapy in recurrent electrical storm, with very few reported complications, except local hematomas. Yet the proximity of major blood vessels and the risk of a sympathetic reaction could expose patients to additional adverse events.

CASE REPORT: We reported the case of a 34-year-old patient, in whom a bilateral SGB was performed after in-hospital cardiac arrest due to recurrent polymorphic ventricular tachycardia. She developed bilateral areflexic mydriasis, diffuse cerebral edema, pneumocephalus, and brainstem herniation and ultimately died from acute intracranial hypertension. We suspected that bilateral SGB, with its most frequent known complications, Horner's syndrome, might have hidden neurological worsening by blunting some clinical signs, which resulted in delayed diagnosis of intracranial hypertension and brain swelling.

CONCLUSIONS

The blocking of sympathetic efferences of the stellate ganglion may result in transient effects that interfere with neurological examination, especially when performed bilaterally.