[Craniocerebral trauma and aseptic osteonecrosis. Steroid-induced sequelae after therapy of brain edema]

Abstract

In this publication we present three cases of avascular osteonecrosis (AON) of the femoral head and the talus in adolescent and young adult patients following short-term, high-dose steroid therapy for cerebral trauma. All patients were proven to be free of other risk factors for AON. The latency period between the steroid therapy and the occurrence of AON ranged from 12 to 60 months; steroid therapy lasted for 12 to 16 days with a total dosage equivalent to 2370-7180 mg prednisolone. Our case reports are added to a review of the literature with 14 similar cases reported receiving short-term, high-dose steroid therapy; 2 of them were also after brain trauma. To the best of our knowledge, 1 of our cases shows the longest latency period ever described after such therapy, and all our cases had a shorter therapy time than reported by other authors who have mentioned brain trauma patients. Additionally, bilateral necrosis of the talus due to short-term, high-dose steroid therapy has also not previously been described. Whereas AON is quite common after long-term steroid therapy (e.g., for immunosuppression and rheumatic disorders), our cases prove that serious complications can occur even after a short period of emergency steroid therapy in cerebral trauma, a possibility that is generally unknown. The minimal dosage and the maximum time steroids can be applied to exclude the risk of AON has not yet been determined, although we do recognize that steroids are useful for the prevention of brain edema.(ABSTRACT TRUNCATED AT 250 WORDS)