Intravenous Dexamethasone as an Adjuvant to Stellate Ganglion Block for Refractory Cerebral Vasospasm After Aneurysmal Subarachnoid Haemorrhage: A Case Report

Refractory cerebral vasospasm after aneurysmal subarachnoid haemorrhage (aSAH) is associated with delayed cerebral ischaemia (DCI) and remains difficult to manage when systemic and endovascular therapies fail.Stellate ganglion block (SGB) is a bedside option that may attenuate the sympathetic component of vasospasm, but its effect is limited by the short duration of local anaesthetics.We describe the case of a 60year-old woman with a modified Fisher Grade IV, Hunt and Hess Grade 3 aSAH from an anterior communicating artery aneurysm, treated with stent-assisted coiling, who developed symptomatic vasospasm refractory to systemic milrinone and intra-arterial therapy.A first ultrasound-guided SGB with ropivacaine was followed by clinical and sonographic improvement and Horner's syndrome lasting less than 24 hours.A second block, with intravenous dexamethasone 8 mg, was followed by a longer-lasting Horner's syndrome (approximately 43 hours), consistent with sustained sympathetic blockade, and by sustained clinical improvement that allowed milrinone to be weaned.No haemorrhagic complications occurred under dual antiplatelet therapy.At six months, her modified Rankin Scale score was one.Because intravenous dexamethasone has anti-inflammatory effects independent of the block, and because concurrent therapies and the natural course of vasospasm may have contributed, the observed response cannot be attributed to prolonged sympathetic blockade alone.This single observation does not establish efficacy; it generates the hypothesis that intravenous dexamethasone may prolong SGB while adding an independent antiinflammatory effect, which warrants evaluation in controlled studies.