Abstract
Introduction THE RATIONALE for the use of adrenal steroids in the prevention and treatment of cerebral edema has been based on both experimental studies and clinical observations. Early experimental work1 showed that steroids could prevent the passage of trypan blue into edematous brain and could help restore a normal electroencephalographic pattern. A clinically smoother postoperative course, reported when patients with craniopharyngiomas were pretreated with steroids,2,3 was felt to be due to a lessening of postoperative edema. More recent clinical reports have further supported the concept of the usefulness of adrenal steroids in cerebral edema.4 Prados1 and more recently Hatanaka5 have proposed that the steroids act directly on the vascular endothelium of the brain whereas Grenell6 believed there may be direct action on the cells. A more exact mechanism of action has not been proposed. Indeed, there may be many modes of action of the

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