Total Reversible Blindness following Attempted Stellate Ganglion Block

Szeinfeld, Marcos; Laurencio, Maria; Pallares, Vicente S.

doi:10.1213/00000539-198109000-00014

Cited by 22 publications

(6 citation statements)

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“…[ 1 2 4 ] A case of blindness and aphasia without respiratory or haemodynamic depression, with complete recovery, was described by Sjeinfield et al . [ 5 ] Scott et al . reported a case of transient unconsciousness, apnoea, expressive aphasia and haemiparesis without haemodynamic changes after the injection of lignocaine into the carotid artery.…”

Section: Discussionmentioning

confidence: 99%

“…[ 1 ] Various complications of SGB include subarachnoid or epidural injection, recurrent laryngeal nerve block, seizures and blindness. [ 2 – 5 ] In addition, aphasia and haemiparesis due to central nervous system (CNS) toxicity, during SGB, has been described by Scott et al . [ 6 ] Dukes and Alexander have described a patient who developed apnoea, paralysis and had vertical eye movement during SGB, and termed it the transient locked-in syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Locked-in syndrome during stellate ganglion block

Chaturvedi

Dash

2010

Indian J Anaesth

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Intra-arterial injection of a local anaesthetic during stellate ganglion blockade may cause life-threatening complications. The usual complications are apnoea, unconsciousness and seizures. However, occasionally an unusual complication, ‘locked-in’ syndrome, has also been reported. In this syndrome the patients remain conscious despite their inability to move, breathe or speak. Here we describe a patient who developed features akin to the locked-in syndrome along with severe hypotension and bradycardia, after an injection of only 2 ml of lignocaine during a stellate ganglion block.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Locked-in syndrome during stellate ganglion block

Chaturvedi

Dash

2010

Indian J Anaesth

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“…SGB is not a risk free procedure. Other serious complications include death, apnoea (Adriani et al, 1952), aphasia, hemiparesis (Scott et al, 1983), fits (Adriani et al, 1952;Korevaar et al, 1979) and transient bilateral blindness (Szeinfeld et al, 1981). Therefore, in the absence of any definite evidence of benefit from the procedure its continued use following quinine overdose should be questioned.…”

Section: Discussionmentioning

confidence: 99%

The management of quinine-induced blindness.

Guly

Driscoll²

1992

Emergency Medicine Journal

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Quinine is rarely taken in overdose (Pearn et al., 1984;Boland et al., 1985). We present a case where blindness resulted from an accidental overdose of only eight tablets of quinine sulphate. Opinion regarding both the aetiology and the management of quinine-induced blindness has altered in recent years (Boland et al., 1984;Dyson et al., 1985;Dyson et al., 1986). This case suggests that expert advice received regarding this condition may not be that recommended in the light of these changes.Case report A 40-year-old man presented to the A&E Department at Hope Hospital at 9 a.m. having become blind overnight. At 8 p.m. the previous day he had developed a mild frontal headache and had taken two of his father's tablets which he believed to be painkillers. His headache did not improve and over the next 8 h he took a further six tablets. During the night he noticed that the street lights became dim and disappeared. When he woke in the morning he was blind and had a buzzing noise in his ears.On examination both pupils were fixed and dilated and there was no light perception in either eye. Fundoscopy was normal. He appeared to have slight hearing impairment but examination was otherwise normal.He brought with him the bottle of tablets he had taken. This contained quinine sulphate tablets which had been prescribed for his father for muscle cramps.Gastric lavage was carried out and repeated doses of activated charcoal were given. The Poisons Information Centre recommended unilateral stellate ganglion block (SGB) after being seen by an opthalmologist. On the advice of the duty ophthalmologist bilateral SGBs were performed at 5.30 p.m.

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“…A total of 16 cases of VA-related complications in the percutaneous nerve block procedures was reported in the literature, which is summarized in Table 2 (63)(64)(65)(66)(67)(68)(69)(70)(71)(72)(73)(74)(75)(76). The complications occurred following stellate ganglion block procedures in the majority of cases.…”

Section: Percutaneous Nerve Block Proceduresmentioning

confidence: 99%

Iatrogenic vertebral artery injury

Inamasu

Guiot

2005

Acta Neurol Scand

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Iatrogenic vertebral artery injury (VAI) results from various diagnostic and therapeutic procedures. The objective of this article is to provide an update on the mechanism of injury and management of this potentially devastating complication. A literature search was conducted using PubMed. The iatrogenic VAIs were categorized according to each diagnostic or therapeutic procedure responsible for the injury, i.e., central venous catheterization, cervical spine surgery, chiropractic manipulation, diagnostic cerebral angiography, percutaneous nerve block, and radiation therapy. The incidence, mechanisms of injury, and reparative procedures were discussed for each type of procedure. The type of VAI depends largely on the type of procedure. Laceration was the dominant type of acute injury in central venous catheterization and cervical spine surgery. Arteriovenous fistulae and pseudoaneurysms were the delayed complications. Arterial dissection was the dominant injury type in chiropractic manipulation and diagnostic cerebral angiography. Inadvertent arterial injection caused seizures or stroke in percutaneous nerve block. Radiation therapy was responsible for endothelial injury which in turn resulted in delayed stenosis and occlusion of the vertebral artery (VA). The proximal VA was the most vulnerable portion of the artery. Although iatrogenic VAIs are rare, they may actually be more prevalent than had previously been thought. Diagnosis of iatrogenic VAI may not always be easy because of its rarity and deep location, and a high level of suspicion is necessary for its early detection. A precise knowledge of the surgical anatomy of the VA is essential prior to each procedure to prevent its iatrogenic injury.

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Total Reversible Blindness following Attempted Stellate Ganglion Block

Cited by 22 publications

References 0 publications

Locked-in syndrome during stellate ganglion block

Locked-in syndrome during stellate ganglion block

The management of quinine-induced blindness.

Iatrogenic vertebral artery injury

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