In veterinary medicine, glucocorticosteroids are commonly used to treat head or spinal trauma; infectious, granulomatous, and necrotizing meningoencephalomyelitis; steroid-responsive meningitis-arteritis; neoplastic diseases; cerebrovascular disease; and hydrocephalus. Adverse effects of steroids in neurologic conditions include increased risk for infection; coagulopathies; hyperglycemia, which may worsen cerebral or spinal cord edema; potentiation of neuron damage when ischemia is present; and inhibition of remyelination of injured neurons. Beneficial effects include protection from free radicals, reduction of intracranial pressure by decreasing production of cerebrospinal fluid, and maintenance of normal microvascular integrity. Glucocorticosteroid therapy may be the only treatment of choice for neoplastic diseases, may be beneficial as a presurgical treatment before intracranial surgery, may be the treatment of choice for some diseases (e.g., steroid-responsive meningitis-arteritis), or may provide temporary relief of clinical signs for which other therapy options are limited (e.g., hydrocephalus where surgery is not an option and granulomatous meningoencephalomyelitis). Head and spinal cord trauma are the 2 most common situations in clinical practice in which the veterinarian must decide whether glucocorticosteroids may be beneficial to the patient. In the case of head trauma, the authors concluded that high-dose corticosteroids created more risk than benefit for the patient. In patients with spinal cord trauma due to disc disease, the authors do not recommend glucocorticoids for early compressive conditions, especially when only back pain is present. In humans, soluble corticosteroids administered within 8 hours of acute trauma have been shown to be beneficial; it is unknown whether this is true in animals. Soluble corticosteroids need to be administered as a slow bolus (30 mg/kg IV followed by 15 mg/kg IV at 2 and 6 hours after the initial dose). Rapid infusion may cause vomiting and gastrointestinal hemorrhage. Lack of species-specific studies (retrospective or prospective) are the major limitation in making evidence-based treatment recommendations.

COMMENTARY: This article is a clear, excellent presentation of common neurologic diseases seen in small animal practice and is particularly useful for its evidence-based approach to steroid treatment options for these diseases. Generations of conflicting information on use of steroids in management of neurologic disease can be confusing for practitioners, and historically many protocols have been borrowed from human medicine trials without equitable comparison trials in animals.

Administering corticosteroids in neurologic disease. Platt SR, Abramson CJ, Garosi LS. COMPEND CONTIN EDUC PRACT VET 27:210-219, 2005.