A double blind study of the effects of dexamethasone on acute stroke was conducted at the Neurological Institute of New York. At the end of the study, it was found that 17 patients had been treated with placebo and 14 patients had been treated with dexamethasone. The dose of steroid was 16 mg daily for 10 days followed by tapering doses from 12 mg to zero over the ensuing 7 days.

The patient’s functional capacity was appraised by the use of a scoring system similar to the system used by the Parkinson Disease Research Foundation for the evaluation of parkinsonism, but adapted for use in stroke. On the basis of the scoring system, patients treated with steroid improved their functional status during the treatment period an average of 12%, while those treated with placebo got worse by 12%. In reviewing the results on the 15 patients most severely affected by their stroke, the benefit with steroid was even more clearly demonstrated because the treated group improved 23% while the placebo group got worse by 14%. These latter results were statistically significant at the P = 0.02 level.

We conclude that dexamethasone can be a useful adjunct to the therapy of the patient with a severe stroke. The suggestion is that the beneficial effects of steroid are in part due to their ability to decrease brain edema secondary to massive brain infarction.