BACKGROUND: Corticosteroids, particularly dexamethasone, are commonly used for 
treatments in patients with subarachnoid haemorrhage (SAH) and primary 
intracerebral haemorrhage (PICH) despite the lack of evidence.
OBJECTIVES: This review aimed: (1) to determine whether corticosteroid therapy 
reduces the proportion of patients who die or have a poor outcome at one to six 
months after the onset of SAH or PICH; (2) to determine whether corticosteroid 
therapy reduces the frequency of delayed cerebral ischaemia (DCI) in patients 
with SAH; (3) to determine the frequency of adverse effects of corticosteroid 
therapy in patients with SAH or PICH within six months of the onset of the 
event.
SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last 
searched November 2003). In addition, we searched MEDLINE (1966 to March 2004) 
and EMBASE (1980 to March 2004), and searched reference lists of relevant 
studies identified. We also made an attempt to identify any relevant ongoing and 
published or unpublished studies by contacting trialists and pharmaceutical 
companies.
SELECTION CRITERIA: We sought to identify all randomised or quasi-randomised 
clinical trials of corticosteroid therapy, in patients with SAH or PICH, that 
have a placebo or standard strategy arm as control. Patients of any age and 
either gender with clinically (bed-side) diagnosed PICH and cerebrospinal fluid 
documented SAH were included in the analysis. The data were analysed both 
separately and combined for computed tomography (CT)/magnetic resonance imaging 
(MRI)/autopsy/angiography verified patients.
DATA COLLECTION AND ANALYSIS: Data extracted from eligible clinical trials 
included: (1) death and poor outcome (death, severe disability, or vegetative 
state) within the first one to six months of the event onset (primary outcomes); 
(2) development of delayed cerebral ischaemia (as defined by the trialists) in 
patients with SAH; and (3) adverse effects of the treatment during the scheduled 
treatment or follow-up period (secondary outcomes). A pooled estimate of the 
effect size was computed, and the test for heterogeneity between trial results 
was carried out using The Cochrane Collaboration's Review Manager software, 
RevMan 4.2. Intention-to-treat analysis was carried out whenever possible.
MAIN RESULTS: Eight trials that fulfilled the eligibility criteria were 
identified, with a total of 256 randomised patients in three SAH trials, and 206 
patients in five PICH trials. The studies differed substantially with regard to 
the study populations and drugs, and methodological quality. The number of 
patients allocated to either hydrocortisone or fludrocortisone acetate treatment 
in patients with SAH, or to dexamethasone treatment in patients with PICH, was 
too small to make any definitive conclusions (confidence intervals were wide for 
any of the outcome estimates).
AUTHORS' CONCLUSIONS: Overall, there is no evidence of a beneficial or adverse 
effect of corticosteroids in patients with either SAH or PICH. Confidence 
intervals are wide and include clinically significant effects in both 
directions.