BACKGROUND: Cerebral vasospasm and sodium and fluid imbalances are common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and cause of significant morbidity and mortality. Studies have shown the benefit of corticosteroids in the management of these sequelae. We have reviewed the literature and analyzed the available data for corticosteroid use after SAH. METHODS: PubMed, EMBASE, and Cochrane electronic databases were searched without language restrictions, and 7 observational, controlled clinical studies of the effect of corticosteroids in the management of SAH patients were identified. Data on sodium and fluid balances, symptomatic vasospasm (SVS), and outcomes were pooled for meta-analyses using the Mantel-Haenszel random effects model. RESULTS: Corticosteroids, specifically hydrocortisone and fludrocortisone, decreased natriuretic diuresis and incidence of hypovolemia. Corticosteroid administration is associated with lower incidence of SVS in the absence of nimodipine, but does not alter the neurological outcome. CONCLUSIONS: Supplementation of corticosteroids with mineralocorticoid activity, such as hydrocortisone or fludrocortisone, helps in maintaining sodium and volume homeostasis in SAH patients. Larger trials are warranted to confirm the effects of corticosteroids on SVS and patient outcomes.
BACKGROUND:Cerebral vasospasm and sodium and fluid imbalances are common sequelae of aneurysmal subarachnoid hemorrhage (SAH) and cause of significant morbidity and mortality. Studies have shown the benefit of corticosteroids in the management of these sequelae. We have reviewed the literature and analyzed the available data for corticosteroid use after SAH. METHODS: PubMed, EMBASE, and Cochrane electronic databases were searched without language restrictions, and 7 observational, controlled clinical studies of the effect of corticosteroids in the management of SAHpatients were identified. Data on sodium and fluid balances, symptomatic vasospasm (SVS), and outcomes were pooled for meta-analyses using the Mantel-Haenszel random effects model. RESULTS: Corticosteroids, specifically hydrocortisone and fludrocortisone, decreased natriuretic diuresis and incidence of hypovolemia. Corticosteroid administration is associated with lower incidence of SVS in the absence of nimodipine, but does not alter the neurological outcome. CONCLUSIONS: Supplementation of corticosteroids with mineralocorticoid activity, such as hydrocortisone or fludrocortisone, helps in maintaining sodium and volume homeostasis in SAHpatients. Larger trials are warranted to confirm the effects of corticosteroids on SVS and patient outcomes.
Authors: Mendel Castle-Kirszbaum; Mervyn Kyi; Christopher Wright; Tony Goldschlager; R Andrew Danks; W Geoffrey Parkin Journal: Neurosurg Rev Date: 2021-01-03 Impact factor: 3.042
Authors: Akshitkumar M Mistry; Jordan A Magarik; Michael J Feldman; Li Wang; Christopher J Lindsell; Matthew R Fusco; Rohan V Chitale; Gordon R Bernard; Wesley H Self; Todd W Rice; Christopher G Hughes; Eva A Mistry; Matthew W Semler Journal: Stroke Vasc Interv Neurol Date: 2022-05-08
Authors: Johannes Walter; Martin Grutza; Markus Möhlenbruch; Dominik Vollherbst; Lidia Vogt; Andreas Unterberg; Klaus Zweckberger Journal: J Clin Med Date: 2022-04-05 Impact factor: 4.241