Cochrane report - A systematic review of mannitol therapy for acute ischemic stroke and cerebral parenchymal hemorrhage

Background-Mannitol was reported to decrease cerebral edema associated with tissue damage and is used to treat acute stroke in many countries. Summary of Review-We tested whether there is any evidence from unconfounded randomized clinical trials that treatment with mannitol reduces short- and long-term case fatality and dependency if administered after ischemic stro ke or cerebral parenchymal hemorrhage. Trials were identified by the standa rd search strategy of the Cochrane Collaboration Stroke Review Group. A sup plementary MEDLINE search was performed, and the Chinese Stroke Trials Regi ster and the Latin-American databank LILACS were checked. A search was perf ormed of master's and PhD degree theses in the databank of Sao Paulo Univer sity and in abstracts of medical congresses on neurology and neurosurgery d uring 1965-1997 in Brazil. Investigators were contacted for unpublished inf ormation. Only truly randomized unconfounded clinical trials were eligible for inclusion. Two of the reviewers independently extracted data from the t rials. Data synthesis and analysis was performed with the use of the Cochra ne Review Manager software RevMan version 4.0.4). Conclusions-Only 1 trial fulfilled the inclusion criteria. The number of in cluded patients was small, and the follow-up was short. Case fatality, the proportion of dependent patients, and side effects were not reported and we re not available from the investigators. As a result of lack of appropriate randomized trials, currently no conclusion can be drawn on the effects of mannitol in acute stroke. The routine use of mannitol in all patients with acute stroke is not supported by evidence from randomized controlled clinic al trials.