Dexamethasone as Treatment in Cerebrovascular Disease. 1. A Controlled Study in Intracerebral Hemorrhage

Tellez, Henry; Bauer, Robert O.

doi:10.1161/01.str.4.4.541

Cited by 125 publications

(40 citation statements)

References 5 publications

(2 reference statements)

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“…Based on the results of two randomized trials that failed to demonstrate the efficacy of corticosteroid therapy in ICH, its use is not indicated. 99,121 The authors of two other small randomized medical trials evaluating hemodilution and therapy with intravenous glycerol also did not find any significant benefit.…”

Section: Neurosurg Focus / Volume 15 / October 2003mentioning

confidence: 96%

“…As reported by Broderick and colleagues, 14 this is reflected in the fact that more than 315 randomized clinical therapeutic trials for acute ischemic stroke and 78 trials for SAH were completed or ongoing as of 1995, whereas only the results of four small randomized surgical trials 6,9,61,84 and four small medical trials of SICH had been published. 55,99,121,135 The American Heart Association formed a task force that published practice guidelines in 1999 for the management of SICH and emphasized the desperate need for future randomized controlled trials. 13 …”

Section: Treatment Of Sichmentioning

confidence: 99%

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Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

144

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Spontaneous intracerebral hemorrhage (SICH) is a blood clot that arises in the brain parenchyma in the absence of trauma or surgery. This entity accounts for 10 to 15% of all strokes and is associated with a higher mortality rate than either ischemic stroke or subarachnoid hemorrhage. Common causes include hypertension, amyloid angiopathy, coagulopathy, vascular anomalies, tumors, and various drugs. Hypertension, however, remains the single greatest modifiable risk factor for SICH. Computerized tomography scanning is the initial diagnostic modality of choice in SICH, and angiography should be considered in all cases except those involving older patients with preexisting hypertension in thalamic, putaminal, or cerebellar hemorrhage. Medical management includes venous thrombosis prophylaxis, gastric cytoprotection, and aggressive rehabilitation. Anticonvulsant agents should be prescribed in supratentorial SICH, whereas the management of hypertension is controversial. To date, nine prospective randomized controlled studies have been conducted to compare surgical and medical management of SICH. Although definitive evidence favoring surgical intervention is lacking, there is good theoretical rationale for early surgical intervention. Surgery should be considered in patients with moderate to large lobar or basal ganglia hemorrhages and those suffering progressive neurological deterioration. Elderly patients in whom the Glasgow Coma Scale score is less than 5, those with brainstem hemorrhages, and those with small hemorrhages do not typically benefit from surgery. Patients with cerebellar hemorrhages larger than 3 cm, those with brainstem compression and hydrocephalus, or those exhibiting neurological deterioration should undergo surgical evacuation of the clot. It is hoped that the forthcoming results of the International Surgical Trial in IntraCerebral Hemorrhage will help formulate evidence-based recommendations regarding the role of surgery in SICH.

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Section: Neurosurg Focus / Volume 15 / October 2003mentioning

confidence: 96%

Section: Treatment Of Sichmentioning

confidence: 99%

Spontaneous intracerebral hemorrhage: a review

Fewel¹,

Thompson²,

Hoff³

2003

FOC

144

View full text Add to dashboard Cite

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“…Osmotherapy is recommended for elevated intracranial pressure (ICP). Corticosteroids are not recommended, because randomized trials in adults with IPH have failed to show efficacy [45,46]. Additionally, hyperglycemia which may result from corticosteroid use has been shown to be detrimental [47,48].…”

Section: Medical Managementmentioning

confidence: 99%

Hemorrhagic Stroke in Children

Jordan

Hillis

2007

Pediatric Neurology

114

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Hemorrhagic stroke accounts for approximately half of stroke in childhood. Unlike arterial ischemic stroke, there are no consensus guidelines to assist in the evaluation and treatment of these children. We review the literature on the evaluation, treatment, etiology and neurologic outcome of hemorrhagic stroke in children. Important differences between pediatric and adult hemorrhage are highlighted, as treatment guidelines for adults may not be applicable in all cases. Needed future research and potential therapies are also discussed.

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“…Four small randomized trials of medical therapy for ICH have been conducted [212][213][214] ; steroid versus placebo treatment 213,215 , hemodilution versus best medical therapy, and glycerol versus placebo 213 . None of the 4 studies has shown any significant benefit for the three therapies.…”

Section: Corticosteroidsmentioning

confidence: 99%