Cervical Sympathetic Block in Patients With Cerebral Vasospasm

Study Overview
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Brief Summary
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The purposes of this study are twofold: 1) to assess the effect of a cervical sympathetic block on cerebral blood flow in patients suffering from cerebral vasospasm, after aneurysmal subarachnoid hemorrhage; 2) to evaluate the effect of the sympathetic block on the recovery of the neurological function.

Detailed Description
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Patients hospitalized in the intensive care unit (ICU) and developing clinical manifestations of cerebral vasospasm will undergo a computerized tomography (CT) angiography and a CT perfusion scan. If the vasospasm will be confirmed by the CT imaging, a cervical sympathetic nerve block under ultrasound guidance will be performed. The block consists in the deposition of local anesthetic at the cervical sympathetic ganglion that will be visualized with an ultrasound device. A periganglionar catheter will be left in place. A CT angiography and CT perfusion will be repeated to check the effect of the block on the brain vasculature after the block is done. Patients will have a daily monitoring of their neurological function and of their cerebral blood flow with transcranial doppler in the ICU.

Official Title
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Cervical Sympathetic Block to Increase Cerebral Blood Flow in Patients With Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage

Conditions
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Anesthesia, Local, Cerebral Vasospasm, Subarachnoid Hemorrhage, Aneurysmal

Intervention / Treatment
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* Procedure: Cervical sympathetic block


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: ages 18 and over patients hospitalized in the ICU and developing cerebral vasospasm after aneurysmal subarachnoid hemorrhage Exclusion Criteria: - known advanced stage kidney disease

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Cervical sympathetic block<br>Patients hospitalized in the ICU and developing clinical manifestations of cerebral vasospasm will undergo a computerized tomography (CT) angiography and a CT perfusion scan. If the vasospasm will be confirmed by the CT imaging, a cervical sympathetic nerve block under ultrasound guidance will be performed. The block consists in the deposition of local anesthetic at the cervical sympathetic ganglion that will be visualized with an ultrasound device. A periganglionar catheter will be left in place. A CT angiography and CT perfusion will be repeated to check the effect of the block on the brain vasculature after the block is done. Patients will have a daily monitoring of their neurological function and of their cerebral blood flow with transcranial doppler in the ICU. | Procedure: Cervical sympathetic block<br>* All participants will get the cervical sympathetic block and catheter under ultrasound guidance.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cerebral blood flow | Cerebral blood flow as measured by computed tomography perfusion | 1 hour after the block | 
| Neurological function | Change in neurological status as assessed by the Glasgow Coma Scale. The Glasgow Coma Scale score can range from 3 (completely unresponsive) to 15 (responsive). | Duration of recovery in ICU (1-2 weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Cerebral blood flow velocity | Transcranial doppler measurement | Daily during recovery in ICU (1-2 weeks) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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regional anesthesia, cervical sympathectomy, cerebral blood flow