1976 Volume 13 Issue 6 Pages 371-377
The effect of steroid therapy on acute cerebrovascular accidents was studied in 66 elderly patients, 38 of which were cases of cerebral infarction, and 28 of cerebral hemorrhage. Twenty three cases of cerebral infarction and 18 cases of cerebral hemorrhage were treated with steroids. The diagnosis was confirmed by autopsy in 47 cases. The average age was 76.2 years. Of 41 steroid treated patients, 22 were treated with predonisolone, 14 with Dexamethasone and 5 with other steroids. The average daily dose of steroids was 10.0mg as a Dexamethasone dose and the average total dose to each patients was 40.4mg. In all cases intravenous administration of steroids was started within 40 hours after stroke and the mean dosed time was 7.2 days.
Improvement of the state of consciousness or survival rate was used as indicators of clinical effect. Consciousness level was divided into 7 grades. Improvement of consciousness level by one grade or more was considered to indicate the effectiveness of the treatment. Survival rate was determined at the end of the second or fourth week.
Results: 1). In cerebral infarction, 9 of 23 treated cases (39%) were improved in their consciousness, whereas 5 of 15 controls (33%) were improved during the same periods. Sixteen of 23 treated cases (70%) survived 4 weeks, while 12 of 15 controls (80%) survived. These differences were not significant. When comparison was made among cases with almost the same level of consciousness, there was no indication of the effectiveness of steroid therapy.
2) In cerebral hemorrhage, 5 of 18 treated cases (27%) were improved in their consciousness, whereas 1 of 10 controls (10%) were improved during the same period. Ten of 18 treated cases (56%) survived 4 weeks, while 1 of 10 controls (10%) survived the same period. In cases of cerebral hemorrhage, disturbance of consciousness at the time of admission was severer in controls than in the cases treated with steroids. because many control cases of cerebral hemorrhage died before they had an opportunity to be treated with steroids. This must be taken into consideration when the results described above are interpreted.
3) Among cases with steroid therapy 3 had gastrointestinal bleeding and 1 had nonketotic hyperosmolar diabetic coma. Gastrointestinal bleeding was also found in one case of controls.
