CASE 9

Title
Stellate Ganglion Block Case Report | November 15, 2018
Shawn Tierney, DC, RSMK Musculoskeletal Sonologist | Taina Danahy, BrainCore Neurofeedback Provider

Diagnosis
Post-Traumatic Stress Disorder (PTSD) & Chronic Adrenal Fatigue

Introduction
The patient had a history of experiencing long-term burnout, impaired memory function and PTSD. He believed the stress of running a large business firm with over 500 employees had led to overall mental, physical and emotional exhaustion. The patient also reported suffering abuse from his father during his adolescence.

The patient’s first quantitative electroencephalogram (qEEG) given by Danahy, the BrainCore Neurofeedback provider at JWP, and it showed that his Beta waves were 95% consumed in PTSD. The Posttraumatic Stress Disorder (PTSD) Checklist, known as the PCL, was given to the patient ; his pre-stellate score was 55.

After discussion of the procedure with the JWP staff, the patient requested the right-side SGB treatment, aimed at increasing his energy, mental clarity and overall brain functionality.

Diagnosis
The needle approach was planned by Dr. Tierney, who examined the anatomy around the patient’s Chassaignac’s tubercle and the path of the vertebral artery , using a high-resolution ultrasound . The exam also confirmed the location of the fascial plane between the longus capitus and longus coli, just anterior to Chassaignac’s tubercle, as well as the path of the C5 and C6 nerve roots.

Treatment
Under ultrasound guidance, 8 mL 0.5% Ropivacaine was injected by NP Bender around the stellate ganglion on the right side of the neck. The anticipated Horner’s syndrome was achieved within five minutes of the block’s completion. The patient was then observed for any post-procedural complications and none were noted.

Follow-up
The patient had a follow-up qEEG the same day as the treatment to assess the immediate effects of the SGB. His brain had already started the reorganizing process by almost 70%, with an overall restructuring change of 34%.

A few weeks after the treatment, the patient reported feeling more focused and alert to tasks that needed to be completed while also feeling a heightened sense of calm and overall less stressed. He still struggled with his sleep and his intimate relations with others, but the fogginess in his brain had lifted and his mental performance had highly improved.

Results
Figure 1. Self-Reported PCL-C, Before & After Stellate Ganglion Block

Conclusion
In conclusion, it was found that the Stellate Ganglion Block injection was an effective solution to the patient’s PTSD symptoms, as demonstrated by the 33% reduction in the patient’s PCL score.