Skip to main content
PMC home page
British Medical Journal (Clinical Research Ed.) logoLink to British Medical Journal (Clinical Research Ed.)
. 1986 Jan 4;292(6512):21–23. doi: 10.1136/bmj.292.6512.21

High dose steroid treatment in cerebral infarction.

J W Norris, V C Hachinski
PMCID: PMC1338973  PMID: 3080050

Abstract

Steroid treatment is widely used in acute cerebral infarction yet its value is controversial. High dose dexamethasone (480 mg over 12 days) was given in a double blind, randomised controlled trial to 113 consecutive eligible patients with acute cerebral infarction admitted to an acute stroke unit. Those with stroke for more than 48 hours, known embolic sources, diabetes, and infection were excluded. Death and quality of survival were recorded over 21 days. The active drug group (54 patients) matched the placebo group (59 patients) for age, initial stroke score, delay in beginning treatment, and other relevant variables. The two groups did not differ significantly in death rate or quality of survivorship. The small difference in mortality between the two groups may have represented a marginal therapeutic effect, which might reach significance in a larger sample. The widespread use of steroids in response to such a marginal therapeutic gain would expose large numbers of patients with stroke to more serious hazards of steroid treatment and convert patients who would otherwise have died into neurovegetative survivors. High dose steroid treatment was ineffective in ischaemic stroke, and the data suggest that further evaluation by a larger multicentre trial is not justified.

Full text

PDF
21

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bauer R. B., Tellez H. Dexamethasone as treatment in cerebrovascular disease. 2. A controlled study in acute cerebral infarction. Stroke. 1973 Jul-Aug;4(4):547–555. doi: 10.1161/01.str.4.4.547. [DOI] [PubMed] [Google Scholar]
  2. Braakman R., Schouten H. J., Blaauw-van Dishoeck M., Minderhoud J. M. Megadose steroids in severe head injury. Results of a prospective double-blind clinical trial. J Neurosurg. 1983 Mar;58(3):326–330. doi: 10.3171/jns.1983.58.3.0326. [DOI] [PubMed] [Google Scholar]
  3. Brown M., Glassenberg M. Mortality factors in patients with acute stroke. JAMA. 1973 Jun 11;224(11):1493–1495. [PubMed] [Google Scholar]
  4. Fishman R. A. Steroids in the treatment of brain edema. N Engl J Med. 1982 Feb 11;306(6):359–360. doi: 10.1056/NEJM198202113060609. [DOI] [PubMed] [Google Scholar]
  5. Katzman R., Clasen R., Klatzo I., Meyer J. S., Pappius H. M., Waltz A. G. Report of Joint Committee for Stroke Resources. IV. Brain edema in stroke. Stroke. 1977 Jul-Aug;8(4):512–540. doi: 10.1161/01.str.8.4.512. [DOI] [PubMed] [Google Scholar]
  6. Mulley G., Wilcox R. G., Mitchell J. R. Dexamethasone in acute stroke. Br Med J. 1978 Oct 7;2(6143):994–996. doi: 10.1136/bmj.2.6143.994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Norris J. W. Comment on "Study design of stroke treatments". Stroke. 1982 Jul-Aug;13(4):527–528. doi: 10.1161/01.str.13.4.527. [DOI] [PubMed] [Google Scholar]
  8. Norris J. W., Hachinski V. C. Misdiagnosis of stroke. Lancet. 1982 Feb 6;1(8267):328–331. doi: 10.1016/s0140-6736(82)91580-x. [DOI] [PubMed] [Google Scholar]
  9. Norris J. W. Steroid therapy in acute cerebral infarction. Arch Neurol. 1976 Jan;33(1):69–71. doi: 10.1001/archneur.1976.00500010071014. [DOI] [PubMed] [Google Scholar]
  10. Patten B. M., Mendell J., Bruun B., Curtin W., Carter S. Double-blind study of the effects of dexamethasone on acute stroke. Neurology. 1972 Apr;22(4):377–383. doi: 10.1212/wnl.22.4.377. [DOI] [PubMed] [Google Scholar]
  11. Peto R., Pike M. C., Armitage P., Breslow N. E., Cox D. R., Howard S. V., Mantel N., McPherson K., Peto J., Smith P. G. Design and analysis of randomized clinical trials requiring prolonged observation of each patient. II. analysis and examples. Br J Cancer. 1977 Jan;35(1):1–39. doi: 10.1038/bjc.1977.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. RUSSEK H. I., RUSSEK A. S., ZOHMAN B. L. Cortisone in immediate therapy of apoplectic stroke. J Am Med Assoc. 1955 Sep 10;159(2):102–105. doi: 10.1001/jama.1955.02960190008003. [DOI] [PubMed] [Google Scholar]
  13. Rubinstein M. K. The influence of adrenocortical steroids on severe cerebrovascular accidents. J Nerv Ment Dis. 1965 Sep;141(3):291–299. doi: 10.1097/00005053-196509000-00005. [DOI] [PubMed] [Google Scholar]
  14. SHAW C. M., ALVORD E. C., Jr, BERRY R. G. Swelling of the brain following ischemic infarction with arterial occlusion. Arch Neurol. 1959 Aug;1:161–177. doi: 10.1001/archneur.1959.03840020035006. [DOI] [PubMed] [Google Scholar]
  15. Taylor D. W., Sackett D. L., Haynes R. B. Sample size for randomized trials in stroke prevention. How many patients do we need? Stroke. 1984 Nov-Dec;15(6):968–971. doi: 10.1161/01.str.15.6.968. [DOI] [PubMed] [Google Scholar]

Articles from British Medical Journal (Clinical research ed.) are provided here courtesy of BMJ Publishing Group

RESOURCES