Effects of Mannitol 20% on Outcomes in Nontraumatic Intracerebral Hemorrhage

Abstract

Background:A large number of stroke patients are not the perfect candidate for craniotomy and invasive procedures, so providing an alternative and noninvasive method, which is applicable in terms of costs and facilities, is necessary. Thus, the present study aimed to determine the effects of mannitol 20% on outcome of the patients with nontraumatic intracerebral hemorrhage (ICH) in patients admitted to Isfahan's Al-Zahra Hospital during 2012 and 2013.Materials and Methods:This is a clinical trial study which is conducted during 2012–2013 in Isfahan's Al-Zahra Hospital. In this study, 41 patients suffering from ICH received mannitol 20% for 3 days, and volume of hemorrhage and Glasgow Coma Scale (GCS) of patients were controlled every 12 h. The collected data were analyzed via SPSS software.Results:The mean ICH volume was 22.1 ± 6.3 ml in pre intervention and 38.4 ± 19.3 ml in post intervention, and according to the t-paired test, before and after treatment the difference was significant (P < 0.001). Hemorrhage volume was stable in nine patients (22%), it increased in 25 patients (61%), and decreased in seven patients (17.1%). The mean index of GCS before and after treatment was 11.85 ± 1.6 and 9.37 ± 2.65, respectively. Moreover according to t-paired test, the difference was significant before and after treatment (P < 0.001). During using mannitol, the GCS index was stable in eight patients (19.5%), it increased in eight patients (19.5%) and decreased in 25 patients (61%).Conclusions:Mannitol injection was not effective in reducing hemorrhage size, and its use is not recommended, also, further studies in this field have been proposed.

Clinical pattern and predictors of stroke treatment outcome among hospitalised patients who had a stroke at Felege Hiwot comprehensive specialised hospital, northwest Ethiopia: a retrospective cross-sectional study

“…In 44.7% of haemorrhagic stroke patients, mannitol was used to reduce cerebral oedema. This is inline with different clinical trials done by Wang et al 57 and Aminmansour et al 58 which reported that the initial use of mannitol at early stage seemed safe but might not reduce haemorrhage size. Cimetidine alone and the combinations of ceftriaxone, metronidazole and cimetidine were the most widely used medications in the treatment of hospital-acquired infections and the prevention of stress-induced ulcer during hospitalisation.…”

“…20 In Africa, the incidence of stroke-related morbidity and mortality is increasing due to the high prevalence of various risk factors such as hypertension, diabetes mellitus, smoking, older age and alcohol. 4 16 21-24 A recent community survey undertaken in African countries showed stroke prevalence was between 200 and 300 per 100 000 populations, 25 and its prevalence is increasing compared with the previous African stroke report (58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68) per 100 000). 26 In sub-Sahara African countries, the estimated lifetime risk of developing stroke was 11.8%.…”

Relationship between edema and intracranial pressure following intracerebral hemorrhage in rat

“…Options range from benign strategies, such as changing patient head position or administration of noninvasive pharmacological treatment (e.g., hyperosmolar therapies, corticosteroids, and other agents that target the BBB), to more invasive neurosurgical options, such as decompressive craniectomy and/or hematoma evacuation (Ropper et al, 1982;Heuts et al, 2013;Takeuchi et al, 2013). Administration of hyperosmolar therapies, such as mannitol (Wang et al, 2015;Aminmansour et al, 2017;Han et al, 2022) or hypertonic saline (Riha et al, 2017;Shah et al, 2018;Han et al, 2022) have thus far shown limited efficacy in human patients, along with corticosteroids such as dexamethasone (Wintzer et al, 2020). Recent guidelines from the American Stroke Association (Greenberg et al, 2022) designate the use of hyperosmolar agents to treat elevated ICP/edema as class 2B (weak evidence for benefit after ICH), while use of corticosteroids are designated as class 3 (evidence of harm after ICH).…”