Steroids, diuretics, and anticonvulsants

Abstract

Edema formation induced by increased vascular permeability worsens tissue damage and exacerbates residual neuronal function. To prevent such secondary damage, many drugs with the potential to reduce edema formation have been used and studied. However, many randomized controlled trials have shown that steroid therapy did not improve neurologic function; on the contrary, steroid therapy caused a higher incidence of side effects. Therefore, steroid administration is not recommended in acute neuronal injury, except for edema associated with brain tumor. Diuretics are used widely in neurosurgery to reduce brain volume and intracranial pressure. Mannitol is effective at doses of 0.25-1 g/kg body weight. Loop diuretics are used as combination drugs with mannitol to facilitate urination. Any cortical damage or irritation associated with brain injury, including that induced by brain surgery, has the potential to induce seizures. Diazepam and phenytoin are widely used to stop seizures. Intravenous anesthetics have anticonvulsant effects.