Summary
The clinical effect of dexamethasone, a potent, synthetic gluco-corticoid, was studied in a large series of neurosurgical patients with brain edema seen over a 12 year period. A protocol was established at the beginning of the study to evaluate the severity of the edema and its clinical response to steroid therapy. The results showed that the treatment of brain edema with dexamethasone was highly effective in patients with focal lesions where edema production persists or progresses with time, as is the case particularly with brain tumors and abscesses. Patients with metastatic tumors, glioblastomas and abscesses responded better to steroid therapy than patients with low grade infiltrating astrocytomas and meningiomas. This correlated well with the relative severity of the edema associated with these respective tumors. Steroid administration proved least effective in patients with generalized brain lesions of acute onset as seen in severe closed head injuries. The prevention of severe operative and post-operative edema in patients started on dexamethasone prior to brain surgery was apparent. This was particularly emphasized in the group of patients who had craniotomies for the excision of large meningiomas and the pathophysiology of this response was discussed. Steroid therapy proved to be safe when administered for the brief period of time usually necessary in neurosurgical problems. Gastrointestinal bleeding was not a serious problem except in very ill patients who were either comatose and on the respirator, or moribund following severe head injuries with brain stem involvement.
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Maxwell, R.E., Long, D.M., French, L.A. (1972). The Clinical Effects of a Synthetic Gluco-Corticoid used for Brain Edema in the Practice of Neurosurgery. In: Reulen, H.J., Schürmann, K. (eds) Steroids and Brain Edema. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-65448-0_25
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