DOI: https://doi.org/10.36347/sjams.2026.v14i02.027

Pages: 303-308

Background: The role of corticosteroids in acute stroke remains controversial and their use in routine clinical practice varies, particularly in severe and hemorrhagic stroke. This study aimed to compare clinical characteristics, complications, mortality and functional outcomes between acute stroke patients who received steroid therapy and those who did not. Methods: This prospective observational comparative study was conducted in the Department of Neurology, National Institute of Neurosciences and Hospital, Dhaka, Bangladesh, from October 2023 to September 2025. A total of 300 adult patients with confirmed acute stroke were enrolled and categorized into steroid-treated (n=180) and non-steroid (n=120) groups. Categorical variables were compared using chi-square test, with p<0.05 considered significant. Results: Most patients were aged 61–70 years (28%), female (59.3%) and had hemorrhagic stroke (55.3%). Severe disability at admission (mRS 5) was present in 79.7%. Overall mortality was 31.3% and favorable follow-up outcome (mRS 0–2) occurred in 17%. Compared with the non-steroid group, steroid-treated patients had higher proportions of hemorrhagic stroke (77.8% vs 51.7%), severe admission disability (86.1% vs 70.0%) and severe GCS ≤8 (47.2% vs 24.2%) (p≤0.002). Complications were more frequent with steroid therapy (61.1% vs 25.8%, p<0.001), while favorable functional recovery was lower (10.0% vs 27.5%, p<0.001). Mortality did not differ significantly (35.6% vs 25.0%, p=0.58). Conclusion: Steroid (Dexamethasone) therapy in acute stroke was mainly used in more severe and hemorrhagic cases and was associated with higher complications and poorer functional recovery without survival benefit. Routine steroid use in acute stroke is not supported.