[Severe Raynaud disease of all four extremities]

A 64-year-old woman presented with a serious Raynaud's disease affecting all four extremities and resulting in fingertip necroses. The symptoms had initiated after her second pregnancy in association with anorexia requiring treatment in a psychosomatic clinic and necessitating parenteral feeding. After successful sympatholysis a sympathectomy was performed. After initial success a recurrence in the right arm was treated by intraarterial prostaglandin infusion. This treatment brought a temporary benefit whereas intravenous infusions had been without effect. A further medical blockade of the stellate ganglion was followed by a complete disappearance of the symptoms. A subsequent re-operation was performed. Since all the cervical branches of the sympathetic nerve cord had been resected during the first intervention, a partial resection of the stellate ganglion (ganglion cervical inferior) was performed. There was a temporary benefit which lasted a few months. Medical long term treatment was unsuccessful. However, no further necroses occurred and the intermittent pain is tolerable.