Mannitol for acute stroke.

Area of Science:

• Neurology
• Clinical Trials
• Pharmacology

Background:

• Mannitol is an osmotic agent and free radical scavenger with potential to reduce edema and tissue damage in stroke.
• Acute stroke, encompassing ischemic stroke and intracerebral hemorrhage (ICH), remains a leading cause of death and disability.

Purpose of the Study:

• To evaluate the efficacy of mannitol in reducing short- and long-term case fatality and dependency following acute ischemic stroke or ICH.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) comparing mannitol with placebo or open control.
• Searches conducted across multiple databases including Cochrane Stroke Group Trials Register, MEDLINE, and others up to January 2007.
• Data extraction and analysis performed independently by two review authors.

Main Results:

• Three small trials with 226 participants were included; one for ischemic stroke and two for CT-verified ICH.
• Primary outcome data (death and dependency) were unavailable in any trial.
• No significant differences in case fatality, death, disability, or clinical improvement were observed between mannitol and control groups in ICH trials. Case fatality was not reported for ischemic stroke.

Conclusions:

• Current evidence is insufficient to support the routine use of mannitol in acute stroke patients.
• Further randomized controlled trials are necessary to definitively establish the benefits or harms of mannitol in acute stroke management.