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Stroke-in-progression, a common yet understudied condition, presents a complex constellation of causes and mechanisms. Further prospective, multicenter research is crucial for a better understanding of this critical neurological event.
Area of Science:
- Neurology
- Neuroscience
- Stroke Medicine
Background:
- Stroke-in-progression (or progressing stroke) is a frequent clinical entity, potentially more common than completed strokes.
- It represents a diverse group of conditions with varied causes, evolutionary patterns, and pathophysiological mechanisms.
- Existing literature on well-studied clinical cases is limited, with many proposed definitions being inadequate.
Purpose of the Study:
- To highlight the clinical significance and underinvestigated nature of stroke-in-progression.
- To advocate for a more robust research approach to this critical neurological condition.
- To challenge the premature dismissal of the progressing stroke concept.
Main Methods:
- Review of existing literature and clinical observations regarding stroke-in-progression.
- Identification of the need for standardized, comprehensive research methodologies.
- Proposal for a prospective, multicenter study design.
Main Results:
- Stroke-in-progression is a complex, heterogeneous condition encompassing various infarct types (large, lacunar, distal) and hemorrhages.
- The current understanding and investigation of progressing stroke are insufficient.
- The concept of progressing stroke is deemed critical and warrants further study, despite suggestions to discard it.
Conclusions:
- The concept of stroke-in-progression should not be discarded due to its commonality and critical nature.
- A comprehensive, prospective, multicenter study is essential for thorough investigation.
- Such a study should incorporate detailed clinical reports, serial neuroimaging (CT, NMR, PET, SPECT), and pathological examinations.
Abstract:
Stroke-in-progression or stroke-in-evolution or progressing stroke is a clinical entity which is frequently encountered in several major types of stroke possibly even more frequently than the classical abruptly completed stroke. Stroke-in-evolution is in fact a mosaic or constellation of conditions including various causes (large infarcts, lacunes, distal fields infarcts, hemorrhages), various types of evolution and various pathophysiological mechanisms. The number of well-studied clinical cases in the literature is surprisingly small. Many of the proposed definitions are not adequate. Although it has been advised that the concept of of progressing stroke be discarded, this advice seems premature considering that it is a common and critical condition and one which has been in fact imperfectly and incompletely investigated. Instead, it would appear better to organize a prospective study with detailed clinical reports, serial CT, angiography, and when possible NMR PET or SPECT and detailed pathological examination of brain and extra-intracranial cerebral arteries. The magnitude of the task is such that a multicenter study would probably be required.