Actions of glucocorticoids and related molecules after traumatic brain injury.

Purpose Of Review: Despite 25 years of randomized, controlled trials, the benefit of steroid administration to patients with traumatic brain injury is unproved. Traditionally, glucocorticoids have been used empirically to reduce inflammation and edema. However, it is becoming apparent that the mechanisms by which steroid molecules might act to improve recovery after traumatic brain injury are numerous.

Recent Findings: The effects of steroid administration on the central nervous system are not uniform but depend on the population of neurons studied. Definite deleterious effects of steroid administration on neuronal survival have been described.

Summary: This review discusses why glucocorticoids might be effective, the considerable laboratory evidence supporting the use of 21-aminosteroids, and the potentially harmful effects of steroid molecules on the brain.