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

¹ Southwarwickshire Hospital, Warwick, UK
² Integrated Medicine, Glenfield Hospital, Leicester, UK
³ Cerebrovascular Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK

Correspondence to:
Dr B Thanvi, Southwarwickshire Hospital, Lakin Road, Warwick CV34 5BW, UK; bthanvi{at}hotmail.com

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.

Keywords: acute stroke; early neurologic deterioration; neurologic