Prednisone Post-Stroke: Is It Safe?

Prednisone is a corticosteroid, and corticosteroids are used to reduce brain swelling in acute ischaemic stroke patients. However, there is no evidence of the benefit of corticosteroids for acute ischaemic stroke. From the small and inadequate amount of evidence available from eight trials involving 466 participants, this review found no benefit of corticosteroids on reducing the number of deaths or improving functional outcomes in survivors.

Prednisone for treating cerebral oedema

Prednisone is a corticosteroid that has been used to treat cerebral oedema, which is a non-specific pathological swelling of the brain that may develop in a focal or diffuse pattern after any type of neurological injury. The underlying cause of this brain swelling is highly variable and relates to multiple physiological cellular changes. The identification and treatment of cerebral oedema is central to the management of critical intracranial pathologies.

Corticosteroids have been used to reduce this brain swelling in order to help limit damage and speed recovery. However, from the small and inadequate amount of evidence available from eight trials involving 466 participants, this review found no benefit of corticosteroids on reducing the number of deaths or improving functional outcome in survivors.

The available evidence suggests hyperosmolar therapy may be helpful in reducing ICP elevations or cerebral oedema in patients with SAH, TBI, AIS, ICH, and HE, although neurological outcomes do not appear to be affected. Corticosteroids appear to be helpful in reducing cerebral oedema in patients with bacterial meningitis, but not ICH.

Prednisone for treating vasculitis

Prednisone is a corticosteroid, also known as a glucocorticoid, that has proven effective in quickly treating inflammation from vasculitis. It is a common first-line treatment for vasculitis, which is an inflammatory condition affecting the blood vessels. The goal of treatment is to reduce inflammation and thereby lessen the symptoms of vasculitis.

Prednisone can be taken as a pill or injected as a shot, typically in the morning. The dosage and method of administration depend on the type and severity of vasculitis. It is important to note that the dosage is usually reduced over time as vasculitis is treated as a chronic condition.

While prednisone is effective in treating vasculitis, long-term use may lead to side effects such as increased infection risk, increased blood sugar, increased blood pressure, loss of bone density, easy bruising, poor healing, weight gain, and changes in appearance due to fat redistribution. Therefore, it is often used in combination with other medications or reduced in dosage over time.

In summary, prednisone is a valuable tool in the treatment of vasculitis, but it should be carefully administered and monitored due to potential side effects. It is typically used as part of a broader treatment plan that may include other medications or procedures depending on the specific type and severity of vasculitis.

Prednisone for treating stroke in sickle cell patients

Prednisone is a corticosteroid used to treat a variety of inflammatory conditions. Sickle cell disease (SCD) is a group of inherited red blood cell disorders that cause red blood cells to become misshapen and break down prematurely. This can lead to a range of complications, including stroke.

Effectiveness of Prednisone in Treating Stroke in Sickle Cell Patients

There is limited evidence on the effectiveness of prednisone in treating stroke in sickle cell patients. However, some studies suggest that prednisone may play a role in reducing inflammation and improving outcomes in these patients.

One study found that prednisone, in combination with cyclophosphamide, was effective in treating isolated angiitis of the central nervous system, an inflammatory condition that can lead to stroke. Another study showed that prednisone improved outcomes in patients with temporal (giant cell) arteritis, a condition that can increase the risk of stroke.

Additionally, prednisone has been used as part of a treatment regimen for primary stroke prevention in sickle cell patients. The Stroke Prevention Trial in sickle cell anemia (STOP) found that long-term transfusion therapy reduced the risk of stroke by 92% in children with sickle cell anemia and abnormal transcranial Doppler ultrasonography results. While prednisone was not the primary treatment in this study, it is often used in conjunction with transfusion therapy to help manage sickle cell crises, including stroke.

Side Effects and Complications

The use of prednisone and other corticosteroids in sickle cell patients can be associated with complications such as avascular necrosis, rebound pain, and stroke. Clinicians may hesitate to prescribe corticosteroids due to these potential side effects and the risk of hospital readmissions.

Vamorolone: A Novel Dissociative Corticosteroid

Vamorolone is a novel dissociative corticosteroid that has been studied as a potential treatment for sickle cell disease. It aims to retain the anti-inflammatory properties of conventional corticosteroids while minimizing their undesirable side effects.

A preclinical trial in sickle cell mice found that vamorolone, similar to prednisone, did not alter the nociception phenotype but decreased white blood cell counts and hepatic inflammation. Interestingly, vamorolone had milder effects on white blood cell counts and hepatic inflammation compared to prednisone.

However, both vamorolone and prednisone were associated with increased hepatic toxicity, particularly in homozygous sickle cell mice. This highlights the potential for liver function deterioration with the use of corticosteroids in sickle cell patients.

Recommendations and Guidelines

The current recommendations for stroke prevention in sickle cell patients focus on the use of transcranial Doppler (TCD) to identify those at risk and packed red blood cell (pRBC) transfusions as the first-line treatment.

• TCD should be performed periodically in children and adolescents with sickle cell disease to detect abnormal blood flow velocities that indicate an increased risk of stroke.
• Chronic pRBC transfusions are recommended as the first-line treatment to prevent primary stroke in sickle cell patients with abnormal TCD velocities (≥200 cm/s).
• After a period of pRBC transfusions, hydroxyurea (HU) can be considered to prevent primary stroke, especially in cases of non-adherence to transfusions, alloimmunization, or blood shortages. HU has been shown to reduce TCD velocities and may be effective in preventing stroke.
• Hematopoietic stem cell transplantation (HSCT) is considered the only curative treatment for sickle cell disease and is recommended for patients with a matched related donor and previous stroke or neurological events.

Prednisone for treating stroke in patients with temporal arteritis

Temporal arteritis, also known as giant cell arteritis, is a serious condition that can lead to blindness and even death if left untreated. It is a form of vasculitis, or inflammation of the blood vessels, that primarily affects the large and medium arteries in the head and neck. The condition is rare, but when it does occur, it can lead to stroke.

The use of corticosteroids, such as prednisone, is the mainstay of treatment for temporal arteritis. High doses of prednisone (40-60mg/day) are typically used to treat the condition, with the goal of suppressing vascular inflammation and reducing the risk of blindness. Treatment should be initiated as early as possible to prevent irreversible damage.

The treatment regimen typically involves an initial high dose of prednisone until the patient's symptoms resolve and inflammatory markers, such as the erythrocyte sedimentation rate (ESR), return to normal. Once the patient has improved, the prednisone dose is gradually tapered over several months to years. This slow taper is important to prevent complications from abrupt cessation of corticosteroid therapy, such as life-threatening adrenal insufficiency.

While corticosteroids are the first-line treatment, new diagnostic techniques, such as Doppler ultrasound, magnetic resonance imaging (MRI) angiography, and positron emission tomography-computed tomography (PET-CT), have emerged as valuable tools for assessing and monitoring patients with temporal arteritis. These techniques can help identify the extent of vascular involvement and guide treatment decisions.

In some cases, endovascular treatment, such as angioplasty, may be considered as a therapeutic option to improve blood flow in affected vessels. However, the overall prognosis for patients with stroke due to temporal arteritis can be poor, with a high risk of recurrence and long-term complications.

Prednisone for treating stroke in patients with reversible cerebral vasoconstriction syndrome

Prednisone is a corticosteroid that has been used to treat acute ischaemic stroke. However, there is no evidence of benefit from corticosteroids for acute ischaemic stroke. The use of corticosteroids in acute ischaemic stroke does not provide evidence of a beneficial effect on death. Nor do the data on neurological impairment or functional outcome suggest any benefit in survivors. There is, therefore, no evidence to support the routine use of corticosteroids in the management of acute ischaemic stroke.

Reversible cerebral vasoconstriction syndrome (RCVS) is a condition that involves the constriction of blood vessels in the brain, which can lead to severe headaches and other neurological problems. RCVS can be treated with calcium channel blockers, high-dose steroids, or magnesium. However, there is limited research on the effectiveness of steroids in treating RCVS. Some studies have shown that glucocorticoid administration is associated with a worse outcome. In contrast, most RCVS patients who are treated with calcium channel antagonists or no therapy have a self-limiting course with a good outcome.

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