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Effect of single mannitol bolus in intracerebral hemorrhage

U K Misra1, J Kalita, A Vajpayee

  • 1Department of Neurology, Sanjay Ghandi PGIMS, Lucknow, India. ukmisra@sgpgi.ac.in

European Journal of Neurology
|August 31, 2007
PubMed

Insights

This study investigated mannitol for intracerebral hemorrhage (ICH). Mannitol showed transient clinical improvement in some patients but did not significantly reduce hematoma or edema in the short term.

Area of Science:

  • Neurosurgery
  • Neurology
  • Clinical Trials

Background:

  • Controversy exists regarding mannitol's efficacy in intracerebral hemorrhage (ICH).
  • Limited data available on single mannitol bolus administration in ICH patients with significant midline shift.

Purpose of the Study:

  • To explore the effects of a single mannitol bolus in patients with supratentorial ICH and midline shift.
  • To assess clinical outcomes and radiological changes following mannitol administration.

Main Methods:

  • Open-label, randomized trial with blinded outcome assessment.
  • Inclusion criteria: CT-proven primary supratentorial ICH with midline shift ≥3 mm.
  • Intervention: Single 20% mannitol bolus (1.5 g/kg) vs. control.
  • Outcome measures: Clinical scales (GCS, CNS), pupillary response, breathing, posturing, pyramidal signs, MRI (horizontal shift, SSS-PMJ distance, edema).

Main Results:

  • No significant baseline differences in demographics or clinical/radiological parameters between mannitol and control groups.
  • Transient clinical improvement observed in 5/12 mannitol-treated patients, lasting 30-60 minutes.
  • No significant changes in horizontal shift or SSS-PMJ distance at 30 or 60 minutes post-mannitol.
  • No significant difference in the change of horizontal shift or SSS-PMJ distance between groups.

Conclusions:

  • Single mannitol bolus may offer transient clinical benefits in ICH patients with midline shift.
  • Mannitol did not demonstrate significant short-term reduction in hematoma or edema-related measures.
  • Further research is needed to clarify the role and optimal use of mannitol in ICH management.

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