Steroids in neuroinfection

Abstract

The consequences of inflammatory response are primarily responsible for morbimortality in bacterial meningitis. Early use of steroids in these cases can reduce mortality and hearing loss and improve functional outcome without causing significant side effects. The formal recommendation towards pneumoccocal meningitis is being extended to other forms of Bacterial Meningitis. The same thought can be applied to tuberculous meningitis. In neurocysticercosis and neuroschistosomiasis steroids are more useful than parasiticides in most cases. Despite the evidence favoring the use of steroids in herpes simplex encephalitis, it is not sufficient to definitely support such indication. Among the opportunistic infections that affect AIDS patients, neurotoxoplasmosis and progressive multifocal leukoencephalopaty are those most often considered for the use of steroids; steroids are safe to use, but no definite benefit could be demonstrated in both conditions.

Reversible dementia due to Neurocysticercosis: improvement of the racemose type with antihistamines

“…Despite the lack of controlled studies, these reports have described positive results in this treatment plan. 24 , 25 , 30 After the second ventricular derivation, this patient remained stable with no further recurrent meningitis or hydrocephalus episodes with the continuous use of antihistamines. We hypothesize that the penetration of dexchlorpheniramine through the blood-brain barrier and its anti-inflammatory properties may play a role in the treatment of NCC, especially in the racemose presentation.…”

“… 24 , 25 , 29 Moreover, some authors have used antihistamines as a substitute for steroids, since NCC is accompanied by prolonged, sometimes recurrent, periods of inflammatory status leading to long-term treatments, and consequently accumulation of steroidal side-effects. 24 , 25 , 30 This replacement was based on knowledge about the immunoallergic mechanisms of the manifestations of NCC and on the fact that steroids do not inhibit the antigen-antibody reaction and the consequent release of histamine and other active substances, whereas antihistamines compete with histamine in their receptors and therefore impair its action. Despite the lack of controlled studies, these reports have described positive results in this treatment plan.…”

Holospinal epidural abscess of the spinal axis: two illustrative cases with review of treatment strategies and surgical techniques

“…The literature does support using steroids to quell this inflammation and to prevent significant morbidity. 1,12,35 In the deteriorating patient with HEA, steroids remain controversial, and further research is necessary to elucidate their efficacy; however the authors believe that the potential benefit outweighs the risks in the acutely deteriorating patient. Blood pressure augmentation is also an area of debate, and has not been studied thoroughly in patients with spinal epidural abscess specifically.…”