Corticosteroids for acute ischaemic stroke.
BACKGROUND
Much of the brain swelling in ischaemic stroke is due to cytotoxic oedema, which is related to cell membrane dysfunction. Early treatment with corticosteroids may help reduce the swelling and improve the outcomes after a stroke.


OBJECTIVE
The objective of this review was to assess the effect of corticosteroids in acute presumed ischaemic stroke.


METHODS
We searched the Cochrane Stroke Group trials register (last searched: 10 April 2001) and contacted investigators in the field.


METHODS
Published randomised trials comparing corticosteroids with placebo or control in people with acute (presumed or definite) ischaemic stroke. Trials were included if treatment began within 48 hours of stroke onset and if clinical outcome was assessed.


METHODS
Two reviewers independently applied the inclusion criteria, assessed trial quality and extracted the data.


RESULTS
Seven trials involving 453 people were included. Details of trial quality that may relate to bias were not available from most trials. No difference was shown in the odds of death within one year (odds ratio 1.08, 95% confidence interval 0.68 to 1.72). Treatment did not appear to improve functional outcome in survivors. Six trials reported neurological impairment but pooling the data was impossible because no common scale or time interval was used. The results were inconsistent between individual trials. The only adverse effects reported were small numbers of gastrointestinal bleeds, infections and deterioration of hyperglycaemia across both groups. Results unchanged since last update.


CONCLUSIONS
There is not enough evidence to evaluate corticosteroid treatment for people with acute presumed ischaemic stroke. Conclusions unchanged since last update.
Qizilbash
N
N
GlaxoSmithKline, New Frontiers Science Park, Third Avenue, Harlow, Essex, UK, CM19 5AW. nawab.qizilbash-1@gsk.com
Lewington
S L
SL
Lopez-Arrieta
J M
JM
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001929:Brain Edema / Q000188:drug therapy* / Q000209:etiology; D002545:Brain Ischemia / Q000150:complications / Q000188:drug therapy; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013256:Steroids; D020521:Stroke / Q000150:complications / Q000188:drug therapy*
D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D013256:Steroids