***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Fifty-four patients with acute cerebral infa rct ion were included in a double-blind study to evaluate Decadron ® as therapy . When comparison of patients with similar levels of consciousness was made , there was no significant difference between those patients receiving Decadron ® and those receiving placebo therapy . Three patients developed gastrointestinal tract bleeding in the placebo group , but there were none in the Decadron ® -treated group . There was no good correlation between the clinical state of the patient and the CSF pressure , either on admission or during the 14-day course of the study Dexamethasone and a placebo were compared as treatment for 40 patients with intracerebral hemorrhage .  Of 19 patients receiving dexamethasone , 17 ( 89.5 % ) died during their hospital admission . Of 21 patients receiving a placebo , 16 ( 76.2 % ) died . The mortality rate was 100 % in 15 patients in the dexamethasone-treated group who were in coma or deep stupor on admission , and the mortality rate was 92 % in 12 patients with similar levels of consciousness who received a placebo . Several parameters of the neurological examination showed an improved quality of survival in the Decadron ® -treated group , but this was found only at certain days in the study . No overall statistically significant difference was found between the two therapies In this study with r and omized controls , we administered fludrocortisone acetate to 46 of 91 patients with subarachnoid hemorrhage in an attempt to prevent excessive natriuresis and plasma volume depletion . Fludrocortisone significantly reduced the frequency of a negative sodium balance during the first 6 days ( from 63 % to 38 % , p = 0.041 ) . A negative sodium balance was significantly correlated with decreased plasma volume during both the first 6 days ( p = 0.014 ) and during the entire 12-day study period ( p = 0.004 ) . Although fludrocortisone treatment tended to diminish the decrease in plasma volume , the difference was not significant ( p = 0.188 ) . More patients in the control group developed cerebral ischemia ( 31 % vs. 22 % ) and , consequently , more control patients were treated with plasma volume exp and ers ( 24 % vs. 15 % ) , which may have masked the effects of fludrocortisone on plasma volume .  Fludrocortisone therefore reduces natriuresis and remains of possible therapeutic benefit in the prevention of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage In an open , r and omized anterospective , comparative study on encephalomalacias it was shown that with regard to the parameter of rehabilitation progress in the degree of paralysis , the patients treated with cortisone had a significantly better performance at the 5 % level . The main point of attack of cortisone appears to be in the early phase of the insult ( first 5 days ) . It seems unlikely that edema control is the only active principle . More probably this is an additional effect on cell metabolism . From these results it seems logical to continue to follow up the acute treatment of cerebral insult with cortisone and search for an optimal dosage and better confirmation A prospect i ve study of 93 acute stroke patients r and omly selected by type of antiedema treatment given ( hypertonic glicerol infusion plus dexamethasone versus dexamethasone alone )  failed to elicit any statistically significant difference between the two treatments on survival rates and quality of survival 7 and 30 days after the stroke Steroid treatment is widely used in acute cerebral infa rct ion yet its value is controversial . High dose dexamethasone ( 480 mg over 12 days ) was given in a double blind , r and omised controlled trial to 113 consecutive eligible patients with acute cerebral infa rct ion admitted to an acute stroke unit . Those with stroke for more than 48 hours , known embolic sources , diabetes , and infection were excluded . Death and quality of survival were recorded over 21 days . The active drug group ( 54 patients ) matched the placebo group ( 59 patients ) for age , initial stroke score , delay in beginning treatment , and other relevant variables . The two groups did not differ significantly in death rate or quality of survivorship . The small difference in mortality between the two groups may have represented a marginal therapeutic effect , which might reach significance in a larger sample . The widespread use of steroids in response to such a marginal therapeutic gain would expose large numbers of patients with stroke to more serious hazards of steroid treatment and convert patients who would otherwise have died into neurovegetative survivors .  High dose steroid treatment was ineffective in ischaemic stroke , and the data suggest that further evaluation by a larger multicentre trial is not justified Intramuscular dexamethasone combined with intravenous low-molecular-weight dextran ( dextran 40 ) was compared with placebo in 40 patients with acute ischaemic cerebral infa rct ion . A double-blind procedure was used . Dexamethasone was given for up to 14 days and dextran 40 for up to three days after the infa rct ion . A weighted scoring system was used to evaluate neurological state and mobility . There were no differences in mortality or in improvement of the neurological or mobility scores between the two groups Fifty-three patients with acute cerebral infa rct ion were treated in a double-blind study with either dexamethasone or placebo within 24 hours of the onset of stroke . Forty-one of these survived for longer than 28 days , and the patients treated with the steroid fared slightly worse than those treated with placebo at the end of this time . Two of the five patients who died in the placebo group died of cerebral edema , compared with three out of seven patients who died in the steroid group . Infectious complications , gastrointestinal hemorrhage , and occasional serious exacerbations of diabetes occurred more commonly in the steroid group In the absence of universally accepted criteria for the medical treatment of stroke , we made a rigorously r and omized comparative study of different treatments in 300 patients . One group of patients received only a general supportive treatment design ed to ensure adequate supplies of water , electrolytes and calories , plus whatever was needed to prevent infection and correct extant associated pathology . Three other groups of patients were treated in the same way but were also given , respectively , one of the following medications : Hydergine ( S and oz ) ( a mixture of three ergot alkaloids ) , dexamethasone , and mannitol . No statistically significant difference emerged among any of the treatment groups and the reference group in terms of objective therapeutic results . The authors concluded that , at least with the dosage used in this study , none of the treatments proved more useful than conventional supportive therapy in the first 10 days after a stroke OBJECTIVE Hospital management of acute ischemic stroke varies greatly within and between different countries . This study assesses the current practice s and opinions of doctors in China routinely involved in the treatment of stroke , and compares them with those of British doctors . METHODS Question naires about the usual management of acute ischemic stroke were sent to 247 Chinese hospitals ( mostly urban ) collaborating in an acute stroke trial , seeking responses from five doctors ( one consultant , two registrars , and two house officers ) in each . After one mailing , 1,095 doctors ( 89 % ) responded . RESULTS Sixty-nine percent of the hospitals had computed tomography scanners , and 88 % of the doctors in those hospitals reported that they would routinely scan acute stroke patients ( 78 % usually within 24 hours of admission and 22 % only later ) . Sixty-two percent of doctors reported average hospital stays of 2 to 4 weeks , whereas 36 % reported longer average stays . Treatments reported to be used routinely within the first 48 hours of acute ischemic stroke included glycerol or mannitol ( 69 % of doctors ) , Chinese herb products ( 66 % ) , calcium antagonists ( 54 % ) , and aspirin ( 53 % ) ; for each of these treatments , over 70 % of all doctors believed it produced definite benefit . Reported routine use of dextran ( 44 % ) ,  snake venom  ( 32 % ) ,  " photo-therapy "  ( 22 % ) , and  steroids  ( 19 % ) was also moderately common , and about half of all doctors believed each was beneficial . In contrast , routine use of  thrombolytic agents  ( 4 % ) or  anticoagulants  ( 1 % ) was uncommon . Only one third of the doctors reported active treatment of hypertension immediately after admission . CONCLUSIONS Comparison with a similar survey in Britain showed reported use of most treatments for acute ischemic stroke was more extensive in China , but that within both countries there was wide variation . The substantial variations in clinical practice both within and between China , the United Kingdom and other countries reflect , at least in part , the substantial uncertainty about the effectiveness of many of the possible treatments for acute ischemic stroke . Large-scale r and omized evidence is needed to confirm or refute the efficacy of these and newer treatments for acute stroke The National Institute of Neurological and Communicative Disorders and Stroke initiated the Stroke Data Bank , which is a multicenter project to prospect ively collect data on the clinical course and sequelae of stroke . Additional objectives were to provide information that would enable a st and ard diagnostic clinical evaluation , to identify prognostic factors , and to provide planning data for future studies . A brief description of the structure and methods precede the baseline characterization of 1,805 patients enrolled in the Stroke Data Bank between July 1983 and June 1986 . Two thirds of these patients were admitted within 24 hours after stroke onset .  Medical history , neurologic history , and hospitalization summaries are presented separately for the following stroke subtypes : infa rct ion , unknown cause ; embolism from cardiac source ; infa rct ion due to atherosclerosis ; lacune ; parenchymatous or intracerebral hemorrhage ; subarachnoid hemorrhage ; and other . The utility and limitations of these data are discussed MRC CRASH is a r and omised controlled trial ( IS RCT N74459797 ) of the effect of corticosteroids on death and disability  after head injury . We r and omly allocated 10,008 adults with head injury and a Glasgow Coma Scale score of 14 or less , within 8 h of injury , to a 48-h infusion of corticosteroid ( methylprednisolone ) or placebo . Data at 6 months were obtained for 9673 ( 96.7 % ) patients . The risk of death was higher in the corticosteroid group than in the placebo group ( 1248 [ 25.7 % ] vs 1075 [ 22.3 % ] deaths ; relative risk 1.15 , 95 % CI 1.07 - 1.24 ; p=0.0001 ) , as was the risk of death or severe disability ( 1828 [ 38.1 % ] vs 1728 [ 36.3 % ] dead or severely disabled ; 1.05 , 0.99 - 1.10 ; p=0.079 ) . There was no evidence that the effect of corticosteroids  differed by injury severity or time since injury . These results lend support to our earlier conclusion that corticosteroids should not be used routinely in the treatment of head injury 10 percent glycerol was given for 6 days to 30 patients who had had acute ischaemic cerebral infa rct ion , and the results were compared with those obtained after treating 31 similar patients with  dexamethasone  ( 16 mg . per 24 hours for 6 days ) . 1 patient treated with glycerol  died of haemoglobinuria and acute renal failure . 6 patients treated with dexamethasone  died--3 from cerebral oedema and 3 from non-neurological complications ( pulmonary embolism , myocardial infa rct ion , and aspiration pneumonia ) . Improvement was significantly greater in the glycerol group after 8 and 15 days . No improvement was noted using either glycerol or dexamethasone in 7 patients with spontaneous intracerebral haemorrhage Over 13 months 118 patients admitted to hospital with acute stroke were allocated at r and om to treatment with either dexamethasone or placebo . At one year there was no significant difference in the numbers of survivors or in the quality of life between the two groups . The results suggest that there is no indication for the routine administration of dexamethasone to a heterogeneous group of patients with stroke To evaluate the efficacy of dexamethasone for treatment of primary supratentorial intracerebral hemorrhage , we studied 93 patients 40 to 80 years old , using a double-blind r and omized block design . After the subjects were stratified according to their level of consciousness ( Glasgow Coma Scale ) , those with objective ly documented primary supratentorial intracerebral hemorrhage were r and omly assigned to either dexamethasone or placebo . For ethical reasons , three interim analyses were planned , to permit early termination of the trial if one study group did better than the other . During the third interim analysis , the death rate at the 21st day was identical in the two groups ( dexamethasone vs. placebo , 21 of 46 vs. 21 of 47 ; chi-square = 0.01 , P = 0.93 ) . In contrast , the rate of complications ( mostly infections and complications of diabetes ) was much higher in the de 
    Output:
    
Treatment did not appear to improve functional outcome in survivors .
The only adverse effects reported were small numbers of gastrointestinal bleeds , infections and deterioration of hyperglycaemia across both groups .
There is not enough evidence to evaluate corticosteroid treatment for people with acute presumed ischaemic stroke .