High-dose dexamethasone is clearly indicated to reduce perilesional oedema in which one of the following settings?

• A Traumatic contusions with mass effect
• B Cytotoxic oedema following a large middle cerebral artery infarct
• C Vasogenic oedema surrounding a meningioma before craniotomy ✓
• D Cerebral oedema following aneurysmal subarachnoid haemorrhage

Explanation

Glucocorticoids specifically reduce vasogenic oedema caused by tumour breakdown of the blood-brain barrier and are standard preoperatively for meningiomas and gliomas. They do not help cytotoxic oedema of infarction. In traumatic brain injury the CRASH trial showed increased death and disability with corticosteroids, so they are contraindicated there, and there is no established benefit after SAH either.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.