Glucocorticoid therapy in neurologic critical care

Gomes, Joao A.; Stevens, Robert D.; Lewin, John J.; Mirski, Marek A.; Bhardwaj, Anish

doi:10.1097/01.ccm.0000166389.85273.38

Cited by 118Traumatic Brain Injury and Neurovascular DisturbancesAcute Ischemic Stroke ManagementAdrenal Hormones and Disorders

Glucocorticoid therapy in neurologic critical care

Gomes, Joao A., Stevens, Robert D., Lewin, John J., Mirski, Marek A., Bhardwaj, Anish·2005·Critical Care Medicine

DOI 10.1097/01.ccm.0000166389.85273.38

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Abstract

BACKGROUND: The pivotal role of inflammation and edema across the spectrum of central nervous system injury has driven extensive investigation into the therapeutic potential of glucocorticoids. OBJECTIVE: To review the experimental and clinical data relating to the efficacy and adverse effects of glucocorticoids in conditions encountered in critical neurologic and neurosurgical illness. DATA SOURCE: Search of MEDLINE and Cochrane databases, manual review of article bibliographies. DATA SYNTHESIS AND CONCLUSIONS: The efficacy of glucocorticoids is well established in ameliorating edema associated with brain tumors and in improving outcome in subsets of patients with bacterial meningitis. Despite frequently encouraging experimental results, clinical trials of glucocorticoids in ischemic stroke, intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, and traumatic brain injury have not shown a definite therapeutic effect. The evidence supporting glucocorticoid therapy for spinal cord injury is controversial; however methylprednisolone continues to be widely employed in this setting.

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Widespread use of glucocorticoids in clinical neurology to control CNS inflammation and poststroke edema is often ineffective and can even worsen clinical outcome.
“While there is widespread use of GCs in clinical neurology to control CNS inflammation in general and poststroke edema in particular, such interventions are often ineffective and can even worsen clinical outcome (Gomes et al., 2005).”
From The Stressed CNS: When Glucocorticoids Aggravate Inflammation (2009) · cites this paper as Gomes et al., 2005

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An inflammatory review of glucocorticoid actions in the CNS
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MATRIX METALLOPROTEINASE INHIBITION ATTENUATES BRAIN EDEMA IN AN IN VIVO MODEL OF SURGICALLY-INDUCED BRAIN INJURY
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Remote Neurodegeneration: Multiple Actors for One Play
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Glucocorticoids Modulate Tumor Radiation Response through a Decrease in Tumor Oxygen Consumption
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Glucocorticoid signaling in myeloid cells worsens acute CNS injury and inflammation
Sorrells, S. F., Caso, J. R., Munhoz, C. D., Hu, C. K., Tran, K. V., Miguel, Z. D., Chien, B. Y., & Sapolsky, R. M. (2013) · The Journal of Neuroscience · doi:10.1523/jneurosci.4705-12.2013 · Cited by 46 · see citing works
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Design and optimization of PLGA microparticles for controlled and local delivery of Neuregulin-1 in traumatic spinal cord injury
Santhosh, K. T., Alizadeh, A., & Karimi‐Abdolrezaee, S. (2017) · Journal of Controlled Release · doi:10.1016/j.jconrel.2017.06.030 · Cited by 41 · see citing works
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Jadhav, V. R. (2008) · Frontiers in bioscience · doi:10.2741/2968 · Cited by 41 · see citing works
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Viscomi, M. T., Florenzano, F., Latini, L., Amantea, D., Bernardi, G., & Molinari, M. (2008) · Neuroscience · doi:10.1016/j.neuroscience.2008.04.024 · Cited by 40 · see citing works
Injury‐induced Janus kinase/protein kinase C‐dependent phosphorylation of growth‐associated protein 43 and signal transducer and activator of transcription 3 for neurite growth in dorsal root ganglion
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Dexamethasone Induces a Specific Form of Ramified Dysfunctional Microglia
Park, M.-J., Park, H.-S., You, M., Yoo, J., Kim, S. H., & Kwon, M. (2018) · Molecular Neurobiology · doi:10.1007/s12035-018-1156-z · Cited by 37 · see citing works
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Travis, Z. D., Sherchan, P., Hayes, W. K., & Zhang, J. H. (2019) · Chinese Neurosurgical Journal · doi:10.1186/s41016-019-0181-8 · Cited by 36 · see citing works
Stress-dose hydrocortisone reduces critical illness-related corticosteroid insufficiency associated with severe traumatic brain injury in rats
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Current Clinical Trials in Traumatic Brain Injury
Ahmed, Z. (2022) · Brain Sciences · doi:10.3390/brainsci12050527 · Cited by 34 · see citing works
Treatment Strategies to Attenuate Perihematomal Edema in Patients With Intracerebral Hemorrhage
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Concepts and Strategies for Clinical Management of Blast-Induced Traumatic Brain Injury and Posttraumatic Stress Disorder
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Targeted Overexpression of Endothelin-1 in Astrocytes Leads to More Severe Cytotoxic Brain Edema and Higher Mortality
Yeung, P. K. K., Lo, A., Leung, J. W. C., Chung, S. S. M., & Chung, S. K. (2009) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1038/jcbfm.2009.175 · Cited by 31 · see citing works
Vestibular disease in dogs: association between neurological examination, MRI lesion localisation and outcome
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Meningitis and Encephalomyelitis in Horses
Pellegrini-Masini, A. M., & Livesey, L. C. (2006) · Veterinary Clinics of North America Equine Practice · doi:10.1016/j.cveq.2006.03.003 · Cited by 29 · see citing works
Acid-base Status and Hemodynamic Stability During Propofol and Sevoflurane-based Anesthesia in Patients Undergoing Uncomplicated Intracranial Surgery
Bonhomme, V. L., Demoitie, J., Schaub, I., & Hans, P. (2009) · Journal of Neurosurgical Anesthesiology · doi:10.1097/ana.0b013e3181963471 · Cited by 26 · see citing works
Endocrinal complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease
Dickerson, H. A., Cooper, D. S., Checchia, P. A., & Nelson, D. P. (2008) · Cardiology in the Young · doi:10.1017/s1047951108002990 · Cited by 24 · see citing works
Dexamethasone in Patients with Spontaneous Intracerebral Hemorrhage: An Updated Meta-Analysis
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Streptococcus pneumoniae meningoencephalitis with unusual and widespread white matter lesions
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Preadmission Use of Glucocorticoids and 30-Day Mortality After Stroke
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Longitudinal enlargement of the lesion after spinal cord injury in the rat: a consequence of malignant edema?
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Effects of dexamethasone in traumatic brain injury patients with pericontusional vasogenic edema
Moll, A., Lara, M., Pomar, J., Orozco, M. O., Frontera, G., Llompart‐Pou, J. A., Moratinos, L., Jiménez, V. G., Ibáñez, J., & Pérez‐Bárcena, J. (2020) · Medicine · doi:10.1097/md.0000000000022879 · Cited by 20 · see citing works
Vulnerability to stroke: implications of perinatal programming of the Hypothalamic-Pituitary-Adrenal axis
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Methylprednisolone improves the survival of new neurons following transient cerebral ischemia in rats
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Effects of Sex Steroids on Damaged Neural Systems
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Hypothalamo-Pituitary-Adrenocortical Axis, Glucocorticoids, and Neurologic Disease
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Documento de consenso sobre el tratamiento de la tuberculosis extrapulmonar y formas complicadas de tuberculosis pulmonar
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Neuropsychological monitoring of cognitive function and ICF–based mental components in patients with malignant brain tumours
Pilarska, A., Pieczyńska, A., & Hojan, K. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1033185 · Cited by 15 · see citing works
Supportive management of patients with brain tumors
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Extensive Spinal Adhesive Arachnoiditis After Extradural Spinal Infection–Spinal Dura Mater Is No Barrier to Inflammation
Krätzig, T., Dreimann, M., Mende, K. C., Königs, I., Westphal, M., & Eicker, S. O. (2018) · World Neurosurgery · doi:10.1016/j.wneu.2018.05.219 · Cited by 15 · see citing works
Endocrine pharmacology
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Pharmacologic management of brain edema
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Self-citation
Abnormal Glucocorticoid Synthesis in the Lesional Skin of Erythematotelangiectatic Rosacea
Hong, J. S., Han, S., Lee, J. S., Lee, C., Choi, M. H., Kim, Y. K., Seo, E. Y., Chung, J. H., & Cho, S. (2019) · Journal of Investigative Dermatology · doi:10.1016/j.jid.2019.02.036 · Cited by 9 · see citing works
Preadmission use of glucocorticoids and risk of cardiovascular events in patients with ischemic stroke
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Authors: Gomes, J. A., Stevens, R. D., Lewin, J. J., Mirski, M. A., & Bhardwaj, A.
Affiliations: Johns Hopkins University (US)
ORCID: Gomes, Joao A.
Stevens, Robert D.
Lewin, John J.
Mirski, Marek A.
Bhardwaj, Anish
Venue: Critical Care Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2005-06
Volume: 33
Issue: 6
Pages: 1214-1224
ISSN: 0090-3493 (ISSN-L)
DOI: 10.1097/01.ccm.0000166389.85273.38
OpenAlex: W2073207619
Cited by: 118
References: 115
Citations by year: 2026: 1 · 2025: 6 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 3 · 2019: 5 · 2018: 6 · 2017: 2 · 2016: 5 · 2015: 4 · 2014: 5 · 2013: 6 · 2012: 7
FWCI: 1.92
Type: journal article
Language: en
Open access: closed
Locations: Critical Care Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Neurological Disorders and Stroke (NS046379, R01NS046379)
Topics: Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
Health Sciences › Medicine › Epidemiology › Acute Ischemic Stroke Management
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
Keywords: glucocorticoids, cerebral edema, inflammation, brain tumors, bacterial meningitis, ischemic stroke, intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, traumatic brain injury, spinal cord injury, methylprednisolone, adverse effects
MeSH terms: Brain Edema, Brain Neoplasms, Central Nervous System Diseases, Central Nervous System Infections, Cerebrovascular Disorders, Glucocorticoids, Humans, Myasthenia Gravis, Trauma, Nervous System

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Glucocorticoid therapy in neurologic critical care

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