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Published on: April 23, 2021
Early Neurological Deterioration in Subcortical Infarcts: A Narrative Review.
Juan José Mengual1, Carmen Montalvo1, Sandra Boned1
1Neurology Department, Complex Hospitalari Universitari Moisès Broggi, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Oriol Martorell 12, 08970 Sant Joan Despí, Spain.
Brain Sciences
|May 27, 2026
Summary
Early neurological deterioration (END) in single small subcortical infarction (SSI) is common and linked to poor outcomes. This review synthesizes evidence on END
Area of Science:
- Neurology
- Vascular Neurology
- Stroke Medicine
Background:
- Early neurological deterioration (END) complicates single small subcortical infarctions (SSI), affecting 20-25% of patients and worsening functional outcomes.
- Current understanding of END definitions, mechanisms, predictors, and treatments in SSI is inconsistent.
- This review addresses the need for synthesized evidence on END in SSI.
Purpose of the Study:
- To review and synthesize current evidence on the incidence, pathophysiology, predictors, and management of END in patients with SSI.
- To highlight the heterogeneity in definitions, mechanisms, and therapeutic strategies for END in SSI.
Main Methods:
- Conducted a narrative review of published studies on END in lacunar stroke or SSI.
- Analyzed data on END definitions, incidence, imaging and clinical predictors, pathophysiological mechanisms, and therapeutic strategies.
Main Results:
- END definitions vary, commonly a ≥2-point NIH Stroke Scale increase within 48-72 hours.
- Hemodynamic compromise from proximal perforator pathology (especially in BAD) is key; advanced imaging reveals a "lacunar penumbra."
- Predictors include lesion topology, infarct patterns, parent artery plaques, larger infarcts, diabetes, inflammation, and arterial stiffness. Early dual antiplatelet therapy and induced hypertension show promise.
Conclusions:
- END in SSI is multifactorial, involving vascular pathology, hemodynamic failure, and tissue vulnerability.
- Standardized definitions, MRI phenotyping, and mechanism-driven trials are crucial for improved risk stratification and targeted therapies.
- Further research is needed to optimize prevention and rescue strategies for END in SSI.
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