Neurocritical Care

36 hours post-injury.

Duration of prophylaxis is typically about 8 weeks.

Controversial topic related to NASCIS-II and NASCIS-III trials

for 24 or 48 hours

Both trials suggested a modest benefit in the first 6 weeks or 6 months (which often did not persist at 1

year) and a modest risk (primarily related to infection). Current guidelines do not support administering

high-dose methylprednisolone.

NASCIS-II split enrolled population in half (those who received the drug before the median time to

administration [8 hours] and those who did not).

Subgroup analysis may not have been powered to show benefit.

Reported motor and sensory scores from one side of the body, not both. The investigators later said

there was no difference but have not allowed others to examine the raw data.

Consistently showed risk (GI bleeding, infection) and inconsistently showed benefit

Potential treatment effects may have been caused by early surgery or additional benefit of high-dose

methylprednisolone therapy in combination with early surgery.

NASCIS-III used a functional independence measure (FIM) score to show how improvement in muscle

strength might translate to improved outcomes. Failed to show a difference in FIM score

If a practitioner does choose to use high-dose steroids in SCI:

Must use methylprednisolone; no other steroids

Must use NASCIS-II or NASCIS-III dosing

Must give within 8 hours of injury

According to the National Brain Tumor Society, an estimated 94,000 Americans received a new primary

brain tumor diagnosis in 2023. Primary brain tumors (from brain cells such as meninges and neural

tissues)

Glioblastoma

Meningioma

Pituitary adenoma

Lung (40%–50%)

Breast (15%–20%)

Melanoma (5%–10%)

Renal cell carcinoma

CNS lymphoma