Effect of IV Dexamethasone on the Outcome of Acute Hemorrhagic Stroke

Background: There is high morbidity and mortality with acute hemorrhagic stroke. The treatment is essentially supportive, and whether outcomes can be improved with the use of corticosteroids is still debatable. Considering the ability of dexamethasone in attenuating cerebral edema as well as inflammatory response, its effect on short-term mortality needs exploration. Objective: To compare the outcome (30-day mortality) between steroids (IV dexamethasone) and placebo in patients with acute hemorrhagic stroke. Study Design: Randomized controlled trial. Duration and Place of Study: This study was conducted from February to May 2025 in the Department of Medicine, Combined Military Hospital, Rawalakot. Methodology: A total of 106 patients aged 16–75 years with CT-confirmed acute hemorrhagic stroke were randomly assigned to two groups (n=53 each) using a lottery method. The treatment group received a structured 10-day course of IV dexamethasone; the control group received visually identical placebo. Demographic and clinical variables including age, gender, BMI, smoking, hypertension, diabetes, and hyperlipidemia were recorded. The primary outcome was all-cause mortality at 30 days. Results: Overall 30-day mortality was lower in the dexamethasone group (26.4%) compared to placebo (43.4%), though not statistically significant (p=0.067). Significant mortality reductions with dexamethasone were noted in subgroups including females (p=0.020), patients over 45 years (p=0.031), BMI >25 (p=0.019), hypertensives (p=0.037), diabetics (p=0.023), smokers (p=0.034), and those with hyperlipidemia (p=0.016). Conclusion: Intravenous dexamethasone may reduce 30-day mortality in acute hemorrhagic stroke, particularly in high-risk subgroups.