Retrospective study from Hamburg, Germany looking at steroid use in subarachnoid hemorrhage.
Study found that use of dexamethasone in patients with SAH who underwent microsurgical clipping or endovascular coiling:
- did not affect hospital mortality
- had a negative effect on the early clinical outcome in the endovascularly treated group
- did not affect early clinical outcome in the microsurgically treated group, but outcome significantly better at 120-day follow-up
Hypothesis on how steroids might possibly improve outcome? Dexamethasone has positive effects in the surgical group (a priori assumption that these patients more likely to have space-occupying hemorrhage and brain edema where surgery is deemed favorable) because the anti-edema effects of dexamethasone may positively influence the post-operative course. Dexamethasone does not work by preventing DCI.
Take home message: Not enough data to routinely recommend starting patients with clipped aneurysmal SAH on dexamethasone. On patients treated with endovascular coiling, dexamethasone shown to have deleterious effects and worse outcomes and therefore, should be avoided.
Czorlich, P. et al. “Impact Of Dexamethasone In Patients With Aneurysmal Subarachnoid Haemorrhage”. European Journal of Neurology (2017): Feb 17. doi: 10.1111/ene.13265. [Epub ahead of print].