Short course of low-dose steroids for management of delayed pericontusional edema after mild traumatic brain injury -...

Secondary insults such as brain edema is commonly observed after traumatic brain injury (TBI) and remains an important cause of neurological deterioration. Based on the corticosteroid randomisation after significant head injury (CRASH) trial findings, Brain Trauma Foundation guidelines recommend against giving steroids in TBI. However, the findings of two recent clinical studies suggest that there may be a subset of patients who may benefit from steroids.

This study was a retrospective, single-center, 4-year study. The study analyzed patients who had received systemic corticosteroids for pericontusional delayed edema after TBI. The time interval to steroid prescription, drug dosage, time to symptomatic improvement, and complications were analyzed.

There were 19 males and eight females. Mean age was 42.1 years (range, 21-91 years). Except for one, all were mild TBI categories. All patients had brain contusions on computed tomography. Dexamethasone was used in tapering doses over 5-10 days, starting with 12 mg/day. The mean interval to steroid prescription after the trauma was 5.9 days, and the mean and median duration was 7 days. All, except one, had symptomatic improvement. The mean time to complete improvement in symptoms was 2.8 days. There were no complications pertinent to steroid usage in any of our cases.

This is the third clinical study to document the efficacy of systemic corticosteroids for delayed cerebral edema after TBI. As steroids are excellent drugs for vasogenic edema, the timing and dosage of steroids are two important factors that will determine their efficacy in TBI. We strongly feel that there needs to be more robust clinical trials with good patient numbers to confirm these findings.