Glucocorticoid therapy in neurologic critical care.
BACKGROUND
The pivotal role of inflammation and edema across the spectrum of central nervous system injury has driven extensive investigation into the therapeutic potential of glucocorticoids.


OBJECTIVE
To review the experimental and clinical data relating to the efficacy and adverse effects of glucocorticoids in conditions encountered in critical neurologic and neurosurgical illness.


METHODS
Search of MEDLINE and Cochrane databases, manual review of article bibliographies.


CONCLUSIONS
The efficacy of glucocorticoids is well established in ameliorating edema associated with brain tumors and in improving outcome in subsets of patients with bacterial meningitis. Despite frequently encouraging experimental results, clinical trials of glucocorticoids in ischemic stroke, intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, and traumatic brain injury have not shown a definite therapeutic effect. The evidence supporting glucocorticoid therapy for spinal cord injury is controversial; however methylprednisolone continues to be widely employed in this setting.
Gomes
Joao A
JA
Neurosciences Critical Care Division, Department of Anesthesia and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Stevens
Robert D
RD
Lewin
John J
JJ
Mirski
Marek A
MA
Bhardwaj
Anish
A
D001929:Brain Edema / Q000503:physiopathology / Q000517:prevention & control; D001932:Brain Neoplasms / Q000188:drug therapy; D002493:Central Nervous System Diseases / Q000188:drug therapy*; D002494:Central Nervous System Infections / Q000188:drug therapy; D002561:Cerebrovascular Disorders / Q000188:drug therapy; D005938:Glucocorticoids / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D009157:Myasthenia Gravis / Q000188:drug therapy; D020196:Trauma, Nervous System / Q000188:drug therapy
D005938:Glucocorticoids