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Stellate ganglion block catheter for paroxysmal sympathetic hyperactivity: calming the ‘neuro-storm’
  1. Man-Cheung Lee1,
  2. Andrew Bartuska1,
  3. Jeffrey Chen1,
  4. Richard K Kim1,
  5. Safwan Jaradeh2 and
  6. Fred Mihm1
  1. 1Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
  2. 2Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California, USA
  1. Correspondence to Dr Fred Mihm, Anesthesia, Stanford University School of Medicine, Stanford, California 94305, USA; fmihm{at}


Background Paroxysmal sympathetic hyperactivity (PSH) is an autonomic disorder affecting patients with severe acquired brain injury characterized by intermittent sympathetic discharges with limited therapeutic options. We hypothesized that the PSH pathophysiology could be interrupted via stellate ganglion blockade (SGB).

Case presentation A patient with PSH after midbrain hemorrhage followed by hydrocephalus obtained near-complete resolution of sympathetic events for 140 days after SGB.

Conclusion SGB is a promising therapy for PSH, overcoming the limitations of systemic medications and may serve to recalibrate aberrant autonomic states.

  • Autonomic Nerve Block
  • Neurologic Manifestations

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  • Contributors M-CL was involved in patient care plans and follow-up and was the key developer of the discussion and literature review required. AB was involved in direct patient care, care plans, extracting patient data from the medical record, writing up the case history, and reviewing manuscript drafts. JC was involved in patient care plans, placement of the stellate ganglion block catheter, production of the procedural video, patient follow-up, and review of manuscript drafts. RKK was involved in patient care plans/consultation and manuscript review/editing and preparation. SJ was involved in patient evaluation and consultation regarding the feasibility of stellate ganglion blockade and was directly involved with manuscript preparation and review. FM was involved in patient care, responsible for the idea of stellate ganglion block and performance of the block, production/editing of the video and figures, manuscript preparation and editing, and overall content of the report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.