Mannitol for acute stroke

Mannitol and Hypertonic Saline Reduce Swelling and Modulate Inflammatory Markers in a Rat Model of Intracerebral Hemorrhage

“…Guidelines from the American Heart Association/American Stroke Association recommend using mannitol in the context of ICH with increased ICP (31). Despite a variety of observational studies (32,33), clinical trials (34,35), and one systematic review (36), no clear long-term benefit of mannitol has been demonstrated. However, in these studies, mannitol invariably was administered in a “reactionary” manner to treat ICP elevations, with variable doses and durations of treatment.…”

Mannitol and Hypertonic Saline Reduce Swelling and Modulate Inflammatory Markers in a Rat Model of Intracerebral Hemorrhage

“…Guidelines from the American Heart Association/American Stroke Association recommend using mannitol in the context of ICH with increased ICP (31). Despite a variety of observational studies (32,33), clinical trials (34,35), and one systematic review (36), no clear long-term benefit of mannitol has been demonstrated. However, in these studies, mannitol invariably was administered in a “reactionary” manner to treat ICP elevations, with variable doses and durations of treatment.…”

Effects of Mannitol 20% on Outcomes in Nontraumatic Intracerebral Hemorrhage

“…[2324] The balance between these two possibilities may, to an extent, explain why a randomized controlled study of mannitol in ICH[25] found no evidence of benefit from administering mannitol, and why the confidence intervals of the odds ratio for case fatality at 30 days and 1 year were wide (with the likelihood of harm as well as benefit in some) in the subgroup of 111 patients with ICH treated with mannitol. [26]…”

Cerebral Edema in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

“…Although a recent paper reviewed anti-edema strategies (25), such treatments in patients with ischemic stroke have never been evaluated in RCTs. No Cochrane data exist on the use of hypertonic saline, and the Cochrane reviews found no evidence to support the routine use of mannitol (26), glycerol (27), or corticosteroids (28) in patients with acute ischemic stroke. Further, there is no proven medical treatment for space-occupying cerebral infarction (29), but as much as 10% of both thrombolysis-treated patients in our cohort and of ischemic stroke patients in general (3) develop massive CED.…”

Mannitol and Hypertonic Saline Reduce Swelling and Modulate Inflammatory Markers in a Rat Model of Intracerebral Hemorrhage

“…Guidelines from the American Heart Association/American Stroke Association recommend using mannitol in the context of ICH with increased ICP (31). Despite a variety of observational studies (32,33), clinical trials (34,35), and one systematic review (36), no clear long-term benefit of mannitol has been demonstrated. However, in these studies, mannitol invariably was administered in a “reactionary” manner to treat ICP elevations, with variable doses and durations of treatment.…”

Effects of Mannitol 20% on Outcomes in Nontraumatic Intracerebral Hemorrhage

“…[2324] The balance between these two possibilities may, to an extent, explain why a randomized controlled study of mannitol in ICH[25] found no evidence of benefit from administering mannitol, and why the confidence intervals of the odds ratio for case fatality at 30 days and 1 year were wide (with the likelihood of harm as well as benefit in some) in the subgroup of 111 patients with ICH treated with mannitol. [26]…”

Cerebral Edema in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

“…Although a recent paper reviewed anti-edema strategies (25), such treatments in patients with ischemic stroke have never been evaluated in RCTs. No Cochrane data exist on the use of hypertonic saline, and the Cochrane reviews found no evidence to support the routine use of mannitol (26), glycerol (27), or corticosteroids (28) in patients with acute ischemic stroke. Further, there is no proven medical treatment for space-occupying cerebral infarction (29), but as much as 10% of both thrombolysis-treated patients in our cohort and of ischemic stroke patients in general (3) develop massive CED.…”

Mannitol and Hypertonic Saline Reduce Swelling and Modulate Inflammatory Markers in a Rat Model of Intracerebral Hemorrhage

“…Guidelines from the American Heart Association/American Stroke Association recommend using mannitol in the context of ICH with increased ICP (31). Despite a variety of observational studies (32,33), clinical trials (34,35), and one systematic review (36), no clear long-term benefit of mannitol has been demonstrated. However, in these studies, mannitol invariably was administered in a “reactionary” manner to treat ICP elevations, with variable doses and durations of treatment.…”

Effects of Mannitol 20% on Outcomes in Nontraumatic Intracerebral Hemorrhage

“…[2324] The balance between these two possibilities may, to an extent, explain why a randomized controlled study of mannitol in ICH[25] found no evidence of benefit from administering mannitol, and why the confidence intervals of the odds ratio for case fatality at 30 days and 1 year were wide (with the likelihood of harm as well as benefit in some) in the subgroup of 111 patients with ICH treated with mannitol. [26]…”

Cerebral Edema in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

“…Although a recent paper reviewed anti-edema strategies (25), such treatments in patients with ischemic stroke have never been evaluated in RCTs. No Cochrane data exist on the use of hypertonic saline, and the Cochrane reviews found no evidence to support the routine use of mannitol (26), glycerol (27), or corticosteroids (28) in patients with acute ischemic stroke. Further, there is no proven medical treatment for space-occupying cerebral infarction (29), but as much as 10% of both thrombolysis-treated patients in our cohort and of ischemic stroke patients in general (3) develop massive CED.…”