title: Glucocorticoid therapy in neurologic critical care.
abstract: 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.
authors.affiliation: Neurosciences Critical Care Division, Department of Anesthesia and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Joao A
authors.initials: JA
authors.lastname: Gomes
authors.forename: Robert D
authors.initials: RD
authors.lastname: Stevens
authors.forename: John J
authors.initials: JJ
authors.lastname: Lewin
authors.forename: Marek A
authors.initials: MA
authors.lastname: Mirski
authors.forename: Anish
authors.initials: A
authors.lastname: Bhardwaj
mesh_terms: 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
chemical_list: D005938:Glucocorticoids