Early neurological deterioration in acute ischaemic stroke: predictors, mechanisms and management

• Published in: Postgraduate medical journal Vol. 84; no. 994; pp. 412 - 417
• Main Authors: Thanvi, B, Treadwell, S, Robinson, T
• Format: Journal Article
• Language: English
• Published: London The Fellowship of Postgraduate Medicine 01.08.2008; BMJ; Oxford University Press
• Subjects: acute stroke; Biological and medical sciences; Blood pressure; Brain Edema - etiology; Brain Ischemia - diagnosis; Brain Ischemia - therapy; Cardiac arrhythmia; Collateral Circulation; Consciousness; Diabetes; Disease Progression; early neurologic deterioration; General aspects; Humans; Medical sciences; Mortality; Nervous System Diseases - etiology; Nervous System Diseases - therapy; neurologic; Neurology; Seizures - etiology; Stroke; Stroke - diagnosis; Stroke - therapy; Terminology as Topic; Vascular diseases and vascular malformations of the nervous system; Veins & arteries; Nervous system diseases; Acute; Prediction; Cardiovascular disease; Nervous system; Mechanism; Cerebral disorder; Vascular disease; Medicine; Clinical management; Central nervous system disease; Brain ischemia; Early; Predictive factor; Cerebrovascular disease
• ISSN: 0032-5473; 1469-0756
• DOI: 10.1136/pgmj.2007.066118

Early neurological deterioration (END) in acute ischaemic stroke is a common event. The underlying mechanisms are heterogeneous. The clinical predictors of END include severity of the initial stroke, large vessel occlusion, diabetes mellitus, hypotension, and atrial fibrillation. Serial observations and detailed assessment by the trained staff in specialised stroke units are key to the successful management of these patients. Advances in brain and vascular imaging have provided insight into the underlying mechanisms, enabling clinicians to use preventative and therapeutic interventions specifically targeted at them, though several questions still remain unanswered. END has potentially serious consequences on the short term (morbidity and death) and long term (recovery from stroke) outcomes for the patient. Therefore, attempts to prevent and treat END should be made promptly and aggressively.