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(Stroke. 2004;35:229.)
© 2004 American Heart Association, Inc.

Controversies in Stroke

Steroids Have No Role in Stroke Therapy

From the Division of Medicine, Department of Neurology, Siriraj Hospital Medical School, Mahidol University, Bangkok, Thailand.

Correspondence to Prof Niphon Poungvarin, Mahidol University - Thailand, Siriraj Hospital Medical School, Dept of Medicine/Division of Neurology, Bangkok, 1070 Thailand. E-mail sinpg@mucc.mahidol.ac.th

Key Words: brain edema • corticosteroids • dexamethasone • stroke, acute

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Steroids are considered as a group of the magic drugs and have been widely used in neurology for more than 40 years. Theoretically, steroids are immunosuppressive agents, lessen the damaging effects of vasogenic cerebral edema, decrease intracranial pressure, and strengthen the blood-brain barrier. However, these possible benefits have to be weighed against potentially serious steroid-related side effects such as immunosuppression and infection, diabetic exacerbation, gastrointestinal hemorrhage, and compromised wound healing.

The place of steroids in the management of stroke is still controversial. As stroke is a heterogeneous condition, it is therefore unlikely that a single agent would be beneficial in any treatment plan. Perhaps the only general agreement on the use of steroids in stroke is where vasculitis is suspected or proven. As a cause of stroke, vasculitis is very rare (<1% of all strokes), but treatment with steroids should be started whenever it is suspected.¹ The effectiveness of steroids as one of the options for the treatment of acute stroke, either hemorrhagic or infarction, has never been shown. So far only 2 randomized, controlled trials concerning the use of dexamethasone in primary supratentorial intracerebral hemorrhage have been reported.^2,3

Tellez and Bauer in 1973 did a trial on 40 patients presumed to have intracerebral hemorrhage and found no beneficial effects of dexamethasone.² There were no CT brain scans available at that period, and 22 patients were later verified to have hemorrhagic infarction or posterior fossa hemorrhage. Poungvarin et al in 1987 conducted a well-designed double-blind controlled trial of dexamethasone in . . . [Full Text of this Article]

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