Ultrasound-Guided Stellate Ganglion Block for Central Post-Stroke Pain: A Case Report and Review

Abstract

Background: Central post-stroke pain (CPSP) is refractory to pharmacotherapy (eg, NSAIDs, opioids, antidepressants, and anticonvulsants), and may require transcranial or deep brain stimulation.

Case presentation: A 67-year-old woman presented with severe paroxysmal cramp-like pain on the right side, including the head and both upper and lower extremities. The pain started 5 years earlier, was initially mild and occasional, but gradually intensified to an unbearable degree with an average of 10-15 daily episodes, each lasting for 5-10 mins. The patient disclosed "hemorrhagic stroke" 10 years ago that resulted in hemiplegia on the right side. CT examination verified the lesion. The patient received daily injection of 2-mL 2% lidocaine under ultrasound guidance to block the stellate ganglion. Pain subsided rapidly in both intensity and frequency. On the seventh day, the patient no longer had pain episodes. At the last follow-up, 9 months later, the patient was free from pain.

Conclusion: Ultrasound-guided stellate ganglion block is a viable alternative for CPSP that is refractory to pharmacotherapy.

Keywords: central post-stroke pain; cramp-like pain; stellate ganglion block; stroke; ultrasound.

Figure 1

Cranial CT (A) upon presentation and (B) 9 months after stellate ganglion block. White arrows: lesions.

Figure 2

A schematic illustration of ultrasound-guided lidocaine injection. Notes: Red arrows: needle trajectory; white arrows: arrows for indications; red-dotted circles: the shapes of the arteries; blue-dotted circle: the wall of internal jugular vein; green-dotted circle: diffusion of local anesthetics; white-dotted line: the shape of transverse process. Abbreviations: ASC, Anterior scalene muscle; CA, Carotid artery; D, Drug; IJV, Internal jugular vein; LC, Longus colli muscle; N, puncture needle; SCM, Sternocleidomastoid muscle; TH; Thyroid gland; TP, Transverse process; VA, Vertebral artery.