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.
Patients hospitalized in the intensive care unit (ICU) and developing clinical manifestations of cerebral vasospasm will be transferred to the neuro-interventional radiology suite for vasospasm treatment. After the vasospasm is confirmed by the angiography followed by a flat panel-computed tomography perfusion (FP-CTP) scan, a cervical sympathetic nerve block under ultrasound guidance will be performed. The block consists of the deposition of local anesthetic at the cervical sympathetic ganglion that will be visualized with an ultrasound device. The local anesthetic solution with be mixed with a radiographic contrast agent to check the spread of the injectate in the desired anatomical location. The spread of the local anesthetic will be assessed by performing an 8-second head/neck C-arm CT scan. Following the block, another run of angiography and a second FP-CTP will be repeated to assess changes in vessels diameter and in perfusion parameters following the sympathetic block. Patients will have a daily monitoring of their neurological function and of their cerebral blood flow with transcranial doppler in the ICU. At 12 months post-aSAH, the patients will complete neurological and neuropsychological assessments as a part of the standard of care. The results of these tests will be collected for analysis.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
10
All participants will get the cervical sympathetic block and catheter under ultrasound guidance.
Stanford University
Stanford, California, United States
Cerebral blood flow
Cerebral blood flow as measured by computed tomography perfusion
Time frame: 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).
Time frame: Duration of recovery in ICU (1-2 weeks)
Cerebral blood flow velocity
Transcranial doppler measurement
Time frame: Daily during recovery in ICU (1-2 weeks)
Executive Functioning - Wisconsin Card Sorting Test (WCST)
Measures executive functioning, including cognitive flexibility and problem-solving. The number of categories completed and total errors will be converted to age-adjusted z-scores. Favorable outcome: z-score ≥ -1.0, unfavorable outcome: z-score \< -1.0 (indicative of cognitive impairment in executive functioning).
Time frame: 12 months post-aSAH
Processing Speed - Symbol Digit Modalities Test (SDMT)
Assesses visual scanning, tracking, and motor speed. Raw scores are adjusted for age and converted to z-scores. Favorable outcome: z-score ≥ -1.0, unfavorable outcome: z-score \< -1.0
Time frame: 12 months post-aSAH
Language - Boston Naming Test (BNT)
Evaluates confrontational word retrieval and naming ability. Scores are standardized using age norms. Favorable outcome: z-score ≥ -1.0, unfavorable outcome: z-score \< -1.0
Time frame: 12 months post-aSAH
Verbal Fluency - FAS Test
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Tests lexical fluency by asking participants to generate words beginning with F, A, and S in a set time period. Z-scores are calculated from age-adjusted norms. Favorable outcome: z-score ≥ -1.0, unfavorable outcome: z-score \< -1.0
Time frame: 12 months post-aSAH
Memory - Hopkins Verbal Learning Test-Revised (HVLT-R)
Assesses verbal learning and memory, including immediate recall, delayed recall, and recognition. Performance is normed and converted into z-scores. Favorable outcome: z-score ≥ -1.0, unfavorable outcome: z-score \< -1.0
Time frame: 12 months post-aSAH
General mental status - Montreal Cognitive Assessment (MoCA)
Screens for mild cognitive impairment across multiple cognitive domains. Raw scores range from 0 to 30. Favorable outcome: MoCA score ≥ 26, unfavorable outcome: MoCA score \< 26 (suggestive of cognitive impairment).
Time frame: 12 months post-aSAH
Functional disability - modified Rankin scale (mRS)
Measurement of functional disability using mRS, categorized as favorable (0-3) or unfavorable (4-6), to assess long-term disability and its association with baseline perfusion.
Time frame: 12 months post-aSAH
Health-Related Quality of Life (HRQoL, SF-36)
HRQoL will be reported as standardized z-scores, with higher scores indicating better performance.
Time frame: 12 months post-aSAH