[Mechanisms of progression of cerebral infarction]

The progression of neurologic symptomatology in the first 48 hours after cerebral infarction appears in more than one third of the patients causing greater morbidity and mortality. Early detection of neurologic deterioration, identification of the predictive factors of worsening and knowledge of the pathogenic mechanisms responsible and their correction make up the basis of the most effective therapy in cerebral infarction. Different hemodynamic alterations (progressive occlusion and growth of the thrombus, insufficiency of colateral circulation, arterial hypotension, etc.) influence, although to different degrees in each patient, in all progressive infarctions. These mechanisms sequentially and progressively condition the necrosis of the areas of ischemic shadow and how new peripheral areas of healthy cerebral tissue are included in the ischemic region, progressively increasing the intensity or the extension of the neurologic manifestations.