A Case of Intractable Hyperhidrosis in Spinal Cord Injury: Role of Stellate Ganglion Block

Abstract

Abstract Objective: Autonomic dysreflexia (AD) in spinal cord injury (SCI) can present as hyperhidrosis due to sudomotor dysfunction. Hyperhidrosis can also occur without an identifiable etiology. There are no standard treatment guidelines for refractory hyperhidrosis in the setting of persistent noxious stimulation. Stellate ganglion blockade may prevent hyperhidrosis by inhibiting profound sympathetic surge and vasoconstriction. Case: 58-year-old female with C7 ASIA-A quadriplegia was admitted to the hospital for episodes of profuse sweating in the setting of autonomic dysreflexia secondary to underlying T7-8 discitis. Despite conservative treatment of discitis, patient continued experience 50-60 episodes of profuse sweating daily. Stellate ganglion block was performed under ultrasound guidance to reduce sympathetic surge. Patient underwent serial stellate ganglion blocks under ultrasound guidance with >75% improvement in her hyperhidrosis episodes. Discussion: Stellate ganglion block is a safe interventional which can be considered for sympathetically mediated refractory hyperhidrosis. It may also be used as a treatment alternative in certain cases of refractory AD in SCI patients. Abstract Objective : Autonomic dysre fl exia (AD) in spinal cord injury (SCI) can present as hyperhidrosis due to sudomotor dysfunction. Hyperhidrosis can also occur without an identi fi able etiology. There are no standard treatment guidelines for refractory hyperhidrosis in the setting of persistent noxious stimulation. Stellate ganglion blockade may prevent hyperhidrosis by inhibiting profound sympathetic surge and vasoconstriction. Case : 58-year-old female with C7 ASIA-A quadriplegia was admitted to the hospital for episodes of profuse sweating in the setting of autonomic dysre fl exia secondary to underlying T7-8 discitis. Despite conservative treatment of discitis, patient continued experience 50 e 60 episodes of profuse sweating daily. Stellate ganglion block was performed under ultrasound guidance to reduce sympathetic surge. Patient underwent serial stellate ganglion blocks under ultrasound guidance with > 75% improvement in her hyperhidrosis episodes. Discussion : Stellate ganglion block is a safe interventional which can be considered for sympathetically mediated refractory hyperhidrosis. It may also be used as a treatment alternative in certain cases of refractory AD in SCI patients.