TBI- Efficacy of Steroids in Acute Vasogenic Edema

Inclusion Criteria: * Age between 18 and 70 years. * Mild or moderate TBI, treated in the emergency department within the first 24-72 hours post-trauma. * Abnormal CT scan with cerebral contusion, with or without midline shift \>3 mm, and/or compression of basal cisterns. * At least 2 systems with abnormal findings on non-invasive monitoring (ONSD ≥6 mm, reduced MCV, PI \>1.3 or MCA FV \<20cm/sec on transcranial Doppler, or ICP waveform with P2\>P1). * Patients with or without polytrauma, with an expected survival of\>24 h. * TBI with brain contusion with medical or surgical procedures indicated within the first 24 h (ventriculostomy, cisternostomy, decompressive craniectomy, or cranial decompression). Exclusion Criteria: * Age \<18 or \>70 years. * Severe TBI (GCS = 3), suspected brain death, or head AIS = 6 (non-survivable injury). * Normal CT scan on initial assessment. * Clinical signs of cerebral herniation upon admission. * Severe polytrauma or massive brain injury with an expected survival \<24 h. * Pre-existing neurological disorders that interfere with outcome assessment, preexisting conditions contraindicating steroid therapy or pre-existing conditions with permanent steroid therapy.