Steroids for stroke: another potential therapy discarded prematurely?

Why do we discard potentially promising therapies so easily? First, the perception that the evidence has been adequately assessed becomes ingrained in the thought processes of everyday practitioners. Second, there is no commercial imperative to drive new trials of therapy. In virtually any modern review of acute stroke therapy, a statement is included that corticosteroids are disproven. However, when the evidence for use of steroids in stroke is examined in more detail, the data seem to be disturbingly sparse. For example, the Cochrane Review of steroids for acute ischemic stroke could identify only 7 trials that …

[1]  R. Bauer,et al.  Dexamethasone as Treatment in Cerebrovascular Disease. 1. A Controlled Study in Intracerebral Hemorrhage , 1973, Stroke.

[2]  F. Joó,et al.  Actinomycin D suppresses the protective effect of dexamethasone in rats affected by global cerebral ischemia. , 1985, Stroke.

[3]  R. Craven,et al.  Isolated angiitis of the central nervous system , 2004 .

[4]  D J Brooks,et al.  Dexamethasone treatment of brain tumor patients , 1985, Neurology.

[5]  V. Hachinski,et al.  High dose steroid treatment in cerebral infarction. , 1986, British medical journal.

[6]  B. Strom,et al.  Effects of dexamethasone in primary supratentorial intracerebral hemorrhage. , 1987, The New England journal of medicine.

[7]  J. De Koninck,et al.  Steroid treatment in acute ischaemic stroke. A comparative retrospective study of 556 cases. , 1988, European neurology.

[8]  S. Jain,et al.  Role of dexamethasone in the outcome from acute stroke. , 1989, The Journal of the Association of Physicians of India.

[9]  G. D. de Courten-Myers,et al.  Efficacious Experimental Stroke Treatment With High‐Dose Methylprednisolone , 1994, Stroke.

[10]  M. Kim,et al.  Isolated Angiitis of the Central Nervous System , 1994 .

[11]  D. Nichols,et al.  Medical and surgical management of intracranial aneurysms. , 1995, Mayo Clinic proceedings.

[12]  R. Myers,et al.  Lobar intracerebral hemorrhage model in pigs: rapid edema development in perihematomal white matter. , 1996, Stroke.

[13]  K. Prasad,et al.  Dexamethasone is not necessarily unsafe in primary supratentorial intracerebral haemorrhage , 1998, Journal of neurology, neurosurgery, and psychiatry.

[14]  N. Yuki,et al.  IgG Anti-GT1a antibodies which do not cross react with GQ1b ganglioside in a pharyngeal-cervical-brachial variant of Guillain-Barré syndrome , 1998, Journal of neurology, neurosurgery, and psychiatry.

[15]  S. Lewington,et al.  Corticosteroids for acute ischaemic stroke. , 2002, The Cochrane database of systematic reviews.

[16]  K. Odusote,et al.  Effectiveness of high dose dexamethasone in the treatment of acute stroke. , 2001, West African journal of medicine.

[17]  Joseph P Broderick,et al.  Natural History of Perihematomal Edema in Patients With Hyperacute Spontaneous Intracerebral Hemorrhage , 2002, Stroke.

[18]  J. Broderick,et al.  Relative Edema Volume Is a Predictor of Outcome in Patients With Hyperacute Spontaneous Intracerebral Hemorrhage , 2002, Stroke.

[19]  V. Feigin,et al.  Stroke epidemiology: a review of population-based studies of incidence, prevalence, and case-fatality in the late 20th century , 2003, The Lancet Neurology.

[20]  NiphonPoungvarin Steroids Have No Role in Stroke Therapy , 2004 .