Treating Mass Effect
Is there any benefit of medically treating
mass effect in ICH?
- Corticosteroids
- Glycerol
- Mannitol
Corticosteroids
Poungvarin N, Bhoopat W, Viriyavejakul A et
al. Effects of dexamethasone in primary supratentorial intracerebral
hemorrhage. N
Engl J Med. 1987; 316: 1229-1233.
- Double Blind, Randomized, Block Design.
- 93 patients with CT confirmed ICH within 48 hours of
the onset were randomized.
- Treatment involved Dexamethasone 10 mg 1st day, then
5 mg every 6 hours for 5 days, then 5 mg every 12 hours
for 2 days, then 5 mg for one day.
- During third interim analysis mortality rates were identical
between two groups, but rate of complications ten times
higher in treated group.
Result: No benefit
Glycerol
Yu YL, Kumana CR, Lauder IJ, et al. Treatment
of acute cerebral hemorrhage with intravenous glycerol:
a double-blind, placebo controlled, randomized trial. Stroke.
1992; 23: 967-971.
- Double-blind, randomized placebo-controlled trial.
- Patients with first stroke, with CT confirmed ICH within
24 hours of onset were recruited.
- 107 received active treatment, 109 given placebo.
- Treatment consisted of 400 cc of 10% glycerol in saline
over 4 hours on 6 consecutive days.
- Outcomes (mortality, improvement in Scandinavian Stroke
Study Group scores, Improvement in Barthal index) measured
at 6 months.
Result: No difference
between groups
Mannitol
Santambrogio S, Martinotti R, Sardella F,
Porro F, Randazzo A. Is there a real treatment for stroke?
Clinical and statistical comparison of different treatments
in 300 patients. Stroke.
1978; 9: 130-132.
Summary of
Medical Treatment of Mass Effect in ICH
- Corticosteroids = No benefit
- Glycerol = No benefit
- Mannitol = No proven benefit
There is no evidence from randomized trials that corticosteroid,
glycerol, or mannitol improves patient outcome.
Hemodilution
Italian Acute Stroke Study Group. Heamodilution
in acute stroke: results of the Italian haemodilution trial.
Lancet
1988; Feb 13: 1 (8581): 318-321.
- 164 patients with ICH within 12 hours of onset, and
Hct > 35% were randomized to either hemodilution or
control.
- 83 patients treated
- 81 patients control
- Therapy: 350 cc blood removed, and 350 cc dextran 40
in 0.9 saline infused
Conclusion: No benefit
Summary of Medical
Management of ICH
No acute medical treatments has been proven to improve
patient outcome after ICH in a randomized trial.
Stroke Education
