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The response of focal ischemic cerebral edema to dexamethasone

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Summary

Twenty-four h after permanent occlusion of the middle cerebral artery (MCA) in the cat, the hemispheric swelling due to edema is markedly reduced under treatment with large doses of dexamethasone than is the case with the untreated group. The increase of regional water and sodium content in the MCA territory is less in the dexamethasone treated group, whereas the potassium changes in the ischemic tissue showed only small differences between the two groups. The potassium content of the non-ischemic tissue is slightly increased in the dexamethasone treated animals when comparing with the untreated group. RISA activity in the tissue is increased in the grey and the white matter of both groups. The less marked RISA−131 activity in the cortical grey matter of the treated animals indicates blood-brain barrier damage of a smaller degree due to dexamethasone. These findings indicate a beneficial effect of dexamethasone on local ischemic edema. Regarding our results and the pharmacokinetics of this steroid the dexamethasone loading of a patient has to be in the range of about 100 mg per day for the adult, and has to be started immediately after the onset of a stroke.

Zusammenfassung

Vierundzwanzig Stunden nach permanentem Verschluß der Arteria cerebri media der Katze ist die ödembedingte Volumenzunahme der geschädigten Hemisphäre unter hochdosierter Dexamethasonbehandlung gegenüber nichtbehandelten Tieren deutlich geringer. Auch der Vergleich der regionalen Wasser- und Natriumzunahme ergibt für die behandelten Tiere geringere Werte. Gleichzeitig findet sich ein nur geringerer Kaliumverlust aus dem geschädigten Gewebe, während sich unter Dexamethasongabe in den ungeschädigten Hirnregionen eine erhöhte Kaliumkonzentration nachweisen läßt. Die RISA−131-Aktivität im Hirngewebe, Indikator für eine Blut-Hirn-Schrankenschädigung, ist 24 h nach Ischämiebeginn sowohl in der grauen als auch der weißen Substanz in beiden Gruppen erhöht, wobei das Ausmaß der BHS-Schädigung im betroffenen Cortexareal der behandelten Gruppe gegenüber den Kontrollen wiederum geringer ist. Diese Befunde sprechen unter Berücksichtigung der Pharmakokinetik des Steroids für eine günstige Wirkung bei der Therapie des lokalen ischämischen Hirnödems. Voraussetzung scheint jedoch die frühzeitige, hochdosierte Steroidgabe zu sein, wobei eine Tagesdosis entsprechend über 100 mg Dexamethason beim erwachsenen Menschen erreicht werden sollte.

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Author notes

  1. U. Hase

    Present address: Department of Neurosurgery, Elisabethenstraße, D-7980, Ravensburg, Germany

Authors and Affiliations

  1. Department of Neurology, University Hospital, Mainz, Langenbeckstr. 1, D-6500, Mainz, Germany

    A. Fenske & M. Fischer

  2. Head of the Department of Neurology, University Lausanne, CH-1011, Lausanne, Switzerland

    F. Regli

  3. Department of Neurosurgery, University Hospital Mainz, Langenbeckstr. 1, D-6500, Mainz, Germany

    U. Hase

Authors
  1. A. Fenske
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  2. M. Fischer
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  3. F. Regli
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  4. U. Hase
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Fenske, A., Fischer, M., Regli, F. et al. The response of focal ischemic cerebral edema to dexamethasone. J Neurol 220, 199–209 (1979). https://doi.org/10.1007/BF00705537

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