The Clinical And Imaging Research Of Stroke In Progression

Neurological deterioration that appears to continue for some time (may be several hours, even several days) following the onset of stroke is defined as stroke in progression (SIP). It is characterized by high incidence (accounting for 26-43% of all the ischemic stroke). SIP seriously affects the prognosis of stroke, the mortality rates increase for more than 4 times caused by the deterioration of nerve function. It is an independent predict factor for the severity of stroke, characterized by its refractoriness. At present, the definition for its time window and diagnostic criteria for the extent of the deterioration are still controversial. The incidence, etiology and pathogenesis of SIP are not yet determined, and there has not yet been any clinical researches related to the clinical typing of SIP and its corresponding mechanisms. For those reasons, our study concentrated on the clinical and imaging feature of SIP, trying to figure out the differences and relations between groups of SIP and their corresponding mechanisms, designing for the formulation of individual treatment.113 SIP patients were selected from the neurological department of the first hospital of JiLin University. The standards to be selected referred to an increase of≥3 scores in The National Institutes of Health Stroke Scale (NIHSS) during the deteriorating courses. We evaluated the general status (including age, sex), risk factors (including hypertension, diabetes, hyperlipoidemia, et al) , the time when the neurological function deteriorating from baseline to the worst status, the clinical feature related to the deterioration, the imaging features, the disposition of cerebrovascular stenosis and so on. Patients were divided into four groups according to their deteriorating forms and the time symptoms reaching to the worst state: the acute progression group, the chronic progression group, the step-like progression group and the wave-like progression group, and we separatively evaluated the risk factors, the imaging characteristics and the features of the stenosis vessels.Results and analyses:①Deteriorating time: Among 113 SIP patients, there were 15 patients (13.27%) whose symptoms worsened during the first 24 hours after stroke. It may be related to the extension of the standard and the higher proportion of lacunar infarction.②The clinical characteristics of SIP: The worsening appeared almost the arms or legs palsy progression, speech and consciousness disorders. Arms or legs palsy progression accounted for 56 patients (49.56%), probably because the motor nerve fibers were widely distributed in the brain.③Infarcts distribution: Next to the body of lateral ventricle in 32 patients (28.32%), 22 patients (19.47%) with watershed were found. These are all watershed areas, lacking of blood supply and collateral circulation, as a result, infarcts in watershed areas are prone to deterioration.④Cerebrovascular stenosis or occlusion: 71 of 113 patients (65.14%) were found with cerebrovascular stenosis. Of all patients with watershed infarcts, 72.22% patients were with cerebrovascular stenosis or occlusion, most of which are MCA and(or) ICA lesion. Prompt changes in hemodynamics is an important mechanism for SIP. It is appropriate to augment cerebral blood flow.⑤With respect to the risk factors, the incidence of hyperglycemia and diabetes in chronic and step-like progression group were more frequent (P<0.05), what's more, the proportions of the chronic and step-like progression group with stenosis vessels were far more than other groups. It is proved that the diabetes-induced cerebrovascular stenosis or occlusions plays an important role in the formation of the SIP. Therefore, it's of great significance to control blood glucose to a normal level.⑥Patients were divided into four groups according to their deteriorating forms and the time symptoms reaching to the worst state: the acute progression group, the chronic progression group, the step-like progression group and the wave-like progression group. The number of chronic and step-like progression group were far more than the other 2 groups. The mechanism of these two groups probably lie in the recurrent hypoperfusion around the lesion areas according to the corresponding vascular stenosis, while the occurrence of wave-like progression group may relates to microemboli. Research conclusions:①Symptoms worsening of SIP is more common after 24 hours. The clinical characteristics are the progressive neurological functions deterioration.②The infarcts in watershed area are more common in SIP.③More watershed infarcts are found with MCA and (or) ICA stenosis or occlusion.④Infarctions with cerebrovascular lesions are prone to deterioration, especially with MCA stenosis.⑤Patients could be divided into four groups according to their deteriorating forms and the time symptoms reaching to the worst state: the acute progression group, the chronic progression group, the step-like progression group and the wave-like progression group. It's helpful for formulation of the individual treatments.