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.
Case Reports—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.
Conclusion—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.
Conflict of Interest—The authors have no conflict of interest to report.
Conflict of interest—Each author certifies that he or she has no commercial association that might pose
a conflict of interest in connection with the submitted manuscript.
Financial Disclosure/Funding—The authors have no financial disclosures