Prasad G Lakshmi
Department of Neurosurgery, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Surg Neurol Int. 2021 Feb 10;12:46. doi: 10.25259/SNI_756_2020. eCollection 2021.
Brain edema is a common phenomenon after traumatic brain injury (TBI) resulting in increased intracranial pressure and subsequent neurological deterioration. Experimental studies have proven that brain edema is biphasic (cytotoxic followed by vasogenic). Till date, all studies, including the corticosteroid randomization after significant head injury (HI) trial, have used high-dose steroids in the acute period during which the edema is essentially cytotoxic in nature. No clinical data exist pertaining to delayed cerebral edema (vasogenic) and steroids.
Patients who had received steroids for delayed cerebral edema after TBI were retrospectively analyzed over a 2-year period. Steroid dose, timing of steroid prescription, time to improvement of symptoms, and complications were noted.
There were six males and three females. Mean age was 41.1 years. There were no severe HI cases. All subjects had cerebral contusions on imaging. Dexamethasone was the preferred steroid starting with 12 mg/day and tapered in 5-7 days. The mean interval to steroid administration after trauma was 7 days. The mean duration of steroid prescription was 6.3 days. All patients had complete symptomatic improvement. The mean time to symptom resolution was 3.8 days. No patients experienced any complications pertinent to steroid usage.
This is the first study to document efficacy of steroids for delayed cerebral edema after TBI, at least in mild/moderate head injuries. The timing of steroid usage and dose of steroids is key aspects that might determine its efficacy in TBI which was the drawbacks of the previous studies. Future prospective trials with the above factors in consideration may confirm/refute above findings.
脑水肿是创伤性脑损伤（TBI）后的常见现象，可导致颅内压升高及随后的神经功能恶化。实验研究已证实脑水肿具有双相性（细胞毒性水肿随后为血管源性水肿）。迄今为止，所有研究，包括重度颅脑损伤（HI）后糖皮质激素随机试验，均在急性期使用高剂量类固醇，而在此期间水肿本质上是细胞毒性的。尚无关于迟发性脑水肿（血管源性）与类固醇的临床数据。
对在2年期间因TBI后迟发性脑水肿接受类固醇治疗的患者进行回顾性分析。记录类固醇剂量、类固醇处方时间、症状改善时间及并发症。
男性6例，女性3例。平均年龄41.1岁。无重度HI病例。所有受试者影像学检查均有脑挫裂伤。地塞米松是首选类固醇，起始剂量为12mg/天，在5 - 7天内逐渐减量。创伤后开始使用类固醇的平均间隔时间为7天。类固醇处方的平均持续时间为6.3天。所有患者症状均完全改善。症状缓解的平均时间为3.8天。无患者出现与类固醇使用相关的任何并发症。
这是第一项记录类固醇对TBI后迟发性脑水肿疗效的研究，至少在轻度/中度颅脑损伤中如此。类固醇的使用时间和剂量是可能决定其在TBI中疗效的关键因素，而这正是既往研究的不足之处。未来考虑上述因素的前瞻性试验可能证实/反驳上述发现。
