Management of Post-Stroke Cold Sensations: A Case Study on Sympathetic Nerve Ablation.

Abstract

BACKGROUND Stroke is a leading cause of mortality worldwide and often results in complex sequelae. Peripheral circulation disorders in paralyzed limbs are particularly challenging, presenting as persistent cold sensations and cold-induced pain that severely impair patients' quality of life. This report presents an innovative approach to managing refractory post-stroke limb coldness and pain using computed tomography (CT)-guided sympathetic nerve radiofrequency ablation. CASE REPORT We present the case of a 65-year-old woman with hemiplegia in her left extremities following a cerebral infarction 1 year earlier. Despite standardized treatment, her condition worsened after 6 months, with increased spasticity, cold-induced pain, and a significant drop in temperature in the left limbs. To address these issues, CT-guided radiofrequency ablation of the sympathetic nerve at the fourth thoracic vertebra and the third lumbar vertebral body was performed at 75°C for 3 min. The procedure significantly improved the peripheral perfusion index, increased palm and foot temperature, and reduced pain. Magnetic resonance imaging revealed improved cerebral infarction and enhanced brain function in temperature-related regions. Ethical approval and patient consent for publication were obtained. CONCLUSIONS CT-guided radiofrequency ablation of the thoracic and lumbar sympathetic nerves effectively alleviates post-stroke peripheral circulation disorders, improves limb temperature, and enhances collateral circulation. This report underscores the importance of awareness and early intervention for such post-stroke complications in patients.