Mannitol in spontaneous intracerebral hemorrhage

Introduction and purpose. Spontaneous intracranial hemorrhage (ICH) is one of the most common cerebrovascular diseases with high disability and mortality. It is a neurological emergency in which a patient presents with high intracranial pressure and signs of impending brain herniation. Mannitol has been widely used in the treatment of cerebral edema, and in lifesaving conditions where brain herniation is imminent. However, several reports have raised its harmful effect over benefit, making its rational use questioned. The purpose of this article is to address the use of mannitol in spontaneous ICH based on its characteristics, the pathophysiology of ICH, and brain edema. Material and method. This review included studies in PubMed, Wiley, and Google Scholar using keywords for relevant literature. State of knowledge. This is a literature review of the current understanding of mannitol’s use in spontaneous intracerebral hemorrhage, considering its behavior in brain edema, its previous use in cerebral lesions, raised intracranial pressure, and functional changes in ICH. Conclusions. Use of mannitol may allow dissimilar outcomes depending on timing of administration, dosage, and patient