Steroids May Have a Role in Stroke Therapy

Few therapeutic responses are more dramatic than theresponse to corticosteroids administered overnight to adrowsy and hemiplegic patient with a cerebral tumor, who next morning is alert with minimal neurological disabil-ity, even though this effect may be short lived. Unfortunately, no such dramatic response is seen in patients with ischemic or hemorrhagic stroke; but does this mean that such therapy is totally ineffective? The categorization of cerebral edema by Klatzo and Seitelberger1 into “cytotoxic ” and “vasogenic” holds the key to this therapeutic response. Cytotoxic, or “intracellular, ” edema represents the earliest response to cerebral damage, and whether ischemic or trau-matic, is due to the breakdown of cellular ionic pumps causing ingress of water into the cell, and confined within the cellular membrane. The clinical effects and response to corticosteroids of this immediate type of edema is uncertain. Vasogenic edema, occurring hours later, is due to damage to