Is Dexamethasone Helpful in Reducing Perihematoma Edema and for the Outcome of Intracerebral Hemorrhage?

Background: In primary supratentorial intracerebral hemorrhage (PSICH), dexamethasone (Dexa) may be effective in reducing perihematoma edema (PHE). We compare the changes in the PHE, hematoma edema complex (HEC), and midline shift (MLS) in patients with PSICH in the Dexa and Non-Dexa groups. Methods: The CT-proven PSICHs were included, and their stroke risk factors, Glasgow Coma Scale (GCS) score, and National Institute of Health Stroke Scale (NIHSS) score were noted. Thirty-one patients received intravenous dexamethasone from day 4 to day 7 of stroke in a dose of 24 mg, 12 mg, and 8 mg daily for 3 days each. Thirty-three patients did not receive dexamethasone. The primary outcome was the change in PHE, HEC, and MLS at 15 days compared to the pre-Dexa CT scan, and the secondary outcomes were death and disability at 3 months and side effects. Results: The Dexa group had a higher volume of ICH, HEC, and PHE, and MLS compared to the Non-Dexa group, although their age, NIHSS and GCS scores were comparable at admission and just before intervention. The Dexa group had a larger reduction in HEC (p = 0.03) and MLS (p < 0.01) compared to the Non-Dexa group. The change in PHE volume was also insignificantly higher in the Dexa group (p = 0.36). At 3 months, the patients with medium (p < 0.001) and large-size hematomas (p < 0.001) in the Dexa group had a good outcome, but this benefit was not observed in small hematomas. Conclusions: In PSICH, dexamethasone after 3 days reduces the HEC and MLS and may have survival and disability benefits especially in medium and large hematomas. A multicentric-randomized-controlled trial may confirm these findings.