Neurológia pre prax 1/2009

Mannitol, hypertonic saline and corticoids in the treatment of intracranial hypertension

Every neurologist is familiar with usage of osmotically active substances and glucocorticoids in the treatment of intracranial hypertension – these medicaments were introduced into clinical practice more than 50 years ago and the abundant literature supporting their role in this indication is convincing. Bearing this in mind, it is even more interesting that we still don’t know the precise mechanism of their action and there is no consensus regarding the ideal dosage of osmotically active substances, timing of treatment and their effectiveness in different indications. Established treatment algorithms are, however, universally accepted and practiced. We briefly summarize the current state of knowledge and practical approach to the management of intracranial hypertension using the above substances and we also point to certain widely accepted fictions that probably lack any rational background.

Keywords: mannitol, hypertonic saline, corticoids, intracranial hypertension.