Steroids

Neuroinflammation and cerebral edema are pivotal in the development of acute brain injury in several neurological and neurosurgical disorders commonly encountered in a neuro-intensive care unit. Corticosteroids’ potent anti-inflammatory, immunomodulatory, and neuroprotective properties can potentially confer benefit in these conditions. However, despite encouraging results in preclinical studies, clinical trials show a definitive therapeutic benefit in only some of these disorders. Moreover, corticosteroids can cause serious adverse effects, especially when used in high, supraphysiological doses and for a prolonged duration. Hence, a rational and evidence-based approach is crucial for ensuring their optimal utilization in a neurocritical care setting. In this chapter, we discuss the fundamental physiological and pharmacological concepts regarding corticosteroids and investigate the evidence regarding their efficacy and safety, during the management of various critical neurological and non-neurological conditions in the neuro-intensive care unit.