Study of drugs used in cerebral edema in patients with stroke at a tertiary care center

Abstract

Background: Various medical and surgical measures have been evolved to treat the raised intracranial pressure (ICP). Medical management mainly involves osmotic agents (glycerol and mannitol), diuretics, and corticosteroids to reduce raised ICP. It is not presently clear whether the routine use of mannitol, glycerol, and corticosteroids results in increased survival and decreased dependency in stroke patients. Aims and Objectives: To study the practice pattern of drugs used in the management of cerebral edema in stroke. Materials and Methods: The retrospective medical records of stroke patients receiving treatment from July 2013 to February 2013 at Fr. Muller Medical College Hospital were reviewed. Data regarding anti-cerebral edema drugs prescribed, co-prescribed drugs was collected from the records. Demographic data, age, gender,hospital medical records number, data regarding anti cerebral edema drugs, co prescribed medicines, clinical outcome in terms of improved/dead/discharged against medical advice, etc., were recorded. Patients above 18 years of age of either sex diagnosed with CVA and on treatment were included in the study. Data were analyzed using suitable statistical methods. Results: According to our study results, drugs were generally not used for the management of cerebral edema. Mannitol was the most common drug used in the management of cerebral edema in stroke (34.93%), followed by furosemide (26.5%), corticosteroids (8.46%), glycerol in 7.23%, and others including torsemide or aldactone (10.84%). Various combinations of these drugs were used. Conclusion: Various combinations of anti-edema drugs were used, no standard protocol was followed, and treatment was highly individualized. Predicting clinical outcome needs development of uniform protocols and further studies to standardize the practice of using drugs to manage cerebral edema routinely in stroke.