Hemifacial Spasm After Ultrasound-Guided Left Stellate Ganglion Block for Post-traumatic Stress Disorder (PTSD): A Case Report

Stellate ganglion block (SGB) is an ultrasound-guided cervical sympathetic block used for pain syndromes and adjunctively for post-traumatic stress disorder (PTSD).Hemifacial spasm (HFS) is a unilateral facial movement disorder usually due to neurovascular compression of cranial nerve VII.A 48-year-old woman with chronic migraine, fibromyalgia, and PTSD underwent an uncomplicated left SGB (C7 level, 6 mL 2% lidocaine).Over 2-3 weeks, she developed new left-sided facial spasms including clusters of orbicularis oculi and lower facial muscle contractions.Neurologic workup included magnetic resonance imaging (MRI) of the brain showing no infarct/mass/lesion and routine electrodiagnostic testing, facial nerve conduction, and electromyography (EMG) of trigeminal/facial muscles, all normal.Botulinum toxin was injected into the left orbicularis oculi with partial transient relief.We propose that SGB-induced head/neck vasodilation and altered sympathetic tone may have converted an asymptomatic neurovascular contact into symptomatic HFS, though causality is unproven.Prior reports note SGB can increase cerebral and cranial perfusion and that sympathetic fibers may bridge facial nerve ephaptic transmission.Clinicians should be aware that new neurologic movement symptoms like HFS, though rare, might follow SGB.Thorough reporting (imaging, labs, consent) and multidisciplinary management are indicated.