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Corticosteroids for aneurysmal subarachnoid haemorrhage and
primary intracerebral haemorrhage (Review)

  Feigin VL, Anderson N, Rinkel GJE, Algra A, van Gijn J, Bennett DA  

  Feigin VL, Anderson N, Rinkel GJE, Algra A, van Gijn J, Bennett DA.  

Corticosteroids for aneurysmal subarachnoid haemorrhage and primary intracerebral haemorrhage.
Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD004583.
DOI: 10.1002/14651858.CD004583.pub2.

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Corticosteroids for aneurysmal subarachnoid haemorrhage and primary intracerebral haemorrhage (Review)
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
 Cochrane Trusted evidence.
Informed decisions.
 
 
Library Better health. Cochrane Database of Systematic Reviews

[Intervention Review]

Corticosteroids for aneurysmal subarachnoid haemorrhage and primary

intracerebral haemorrhage

Valery L Feigin1, Neil Anderson2, Gabriel JE Rinkel3, Ale Algra4, Jan van Gijn3, Derrick A Bennett5

1Faculty of Health & Environmental Sciences, Auckland University of Technology, Auckland, New Zealand. 2Department of Medicine,
University of Auckland, Auckland, New Zealand. 3Department of Neurology, University Medical Center Utrecht, Utrecht, Netherlands.
4Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands. 5Clinical Trials Service
Unit and Epidemiological Studies Unit, Oxford University, Oxford, UK

Contact address: Valery L Feigin, Faculty of Health & Environmental Sciences, Auckland University of Technology, Private Bag 92006,
Auckland, 1142, New Zealand. valery.feigin@aut.ac.nz.

Editorial group: Cochrane Stroke Group.

Publication status and date: Edited (no change to conclusions), published in Issue 1, 2010.

Citation: Feigin VL, Anderson N, Rinkel GJE, Algra A, van Gijn J, Bennett DA. Corticosteroids for aneurysmal subarachnoid
haemorrhage and primary intracerebral haemorrhage. Cochrane Database of Systematic Reviews 2005, Issue 3. Art. No.: CD004583. DOI:
10.1002/14651858.CD004583.pub2.

Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

ABSTRACT

Background
Corticosteroids, particularly dexamethasone, are commonly used for treatments in patients with subarachnoid haemorrhage (SAH) and
primary intracerebral haemorrhage (PICH) despite the lack of evidence.

Objectives
To determine: (1) whether corticosteroid therapy reduces the proportion of patients who die or have a poor outcome at one to six months
after the onset of SAH or PICH; (2) whether corticosteroid therapy reduces the frequency of delayed cerebral ischaemia in patients with
SAH; (3) the frequency of adverse effects of corticosteroid therapy in patients with SAH or PICH within six months of the onset of the event.

Search methods
We searched the Cochrane Stroke Group Trials Register (last searched November 2003). In addition, we searched MEDLINE (1966 to March
2004) and EMBASE (1980 to March 2004), and searched reference lists of relevant studies identified. We attempted to identify any relevant
ongoing and published or unpublished studies by contacting trialists and pharmaceutical companies.

Selection criteria
We sought to identify all randomised or quasi-randomised clinical trials of corticosteroid therapy, in patients with SAH or PICH, that have a
placebo or standard strategy arm as control. Data were analysed both separately and combined for computed tomography (CT)/magnetic
resonance imaging (MRI)/autopsy/angiography verified patients.

Data collection and analysis

Data extracted from eligible clinical trials included: (1) death and poor outcome (death, severe disability, or vegetative state) within the
first one to six months of the event onset (primary outcomes); (2) development of delayed cerebral ischaemia in patients with SAH; and
(3) adverse effects of the treatment during the scheduled treatment or follow-up period (secondary outcomes). A pooled estimate of the
effect size was computed, and the test for heterogeneity between trial results was carried out. Intention-to-treat analysis was carried out
whenever possible.

Corticosteroids for aneurysmal subarachnoid haemorrhage and primary intracerebral haemorrhage (Review) 1
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
 Cochrane Trusted evidence.
Informed decisions.
 
 
Library Better health. Cochrane Database of Systematic Reviews

Main results
Eight trials, with 256 randomised patients in three SAH trials and 206 patients in five PICH trials, were included. The studies differed
substantially with regard to the study populations and drugs, and methodological quality. The number of patients allocated to either
hydrocortisone or fludrocortisone acetate treatment in patients with SAH, or to dexamethasone treatment in patients with PICH, was too
small to make any definitive conclusions.

Authors' conclusions
Overall, there is no evidence of a beneficial or adverse effect of corticosteroids in patients with either SAH or PICH. Confidence intervals
are wide and include clinically significant effects in both directions.

PLAIN LANGUAGE SUMMARY

Corticosteroids for aneurysmal subarachnoid haemorrhage and primary intracerebral haemorrhage

There is no evidence of benefit from corticosteroids for patients with stroke due to bleeding. About one fifth of all strokes are due to
bursting of an artery. The burst artery causes bleeding into the brain itself (called intracerebral haemorrhage) or into the space around
the brain (called subarachnoid haemorrhage). After either type of bleed the brain tissue may become swollen. The swelling causes a rise
in pressure which can cause further brain damage or even death. Corticosteroids could reduce swelling after brain haemorrhage and so
improve the chances of the patient recovering. However, corticosteroids can also have important adverse effects such as increased blood
sugars, infection, and gastrointestinal bleeding. The trials included in this review had too few participants to provide reliable evidence on
any benefits weighed against harms of this treatment for patients with stroke due to bleeding in the brain.

Corticosteroids for aneurysmal subarachnoid haemorrhage and primary intracerebral haemorrhage (Review) 2
Copyright © 2010 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.