Controversy surrounds the role of steroids in the treatment of intracerebral haemorrhage.1 Theoretically, the short term use of dexamethasone is justified because it lessens the damaging effects of cerebral oedema, decreases intracranial pressure, and strengthens the blood-brain barrier. However, the possible benefit has to be weighed against the risk of complications, especially infections and gastrointestinal haemorrhage.2

So far, only two randomised, controlled trials concerning this controversy have been reported. One trial of 40 patients assumed to have intracerebral haemorrhage, found no beneficial effects of steroids.3 However, this study had 22 patients with haemorrhagic infarcts or posterior fossa haemorrhage, and the outcome measures used had little clinical relevance regarding functional ability of the patients. The other trial, from Thailand,4was well designed, but had to be terminated prematurely after an interim analysis disclosed lack of benefit and presence of clinically important adverse effects. Patients in the dexamethasone group had more frequent infections, gastrointestinal haemorrhage, and diabetogenic effect, than the placebo group. There was a possible longer early survival in a subgroup with less severe stroke. Good recovery was noted in 17% of patients in the dexamethasone group, compared with 10% of …