[Apoplexy with rapidly deteriorating symptoms--"stroke in progression". Hemodynamic and clinical aspects]

Stroke-in-progression, SIP, occurs in about 30% of patients with acute stroke and negatively affects the prognosis and mortality. The underlying caused are thought to be clot propagation, cerebral haemorrhage or oedema. In some cases these rather obvious mechanisms cannot be demonstrated, and other variables such as a decrease in blood pressure must be considered as major factors. In this paper the basic haemodynamic mechanisms of cerebral blood flow and the relevant pathophysiology of focal cerebral infarcts are described with emphasis on the penumbra. In addition, available clinical studies are reviewed and current treatment discussed. Our main conclusion is that to assure sufficient collateral flow a high perfusion pressure must be maintained, and we advocate withholding antihypertensive therapy during the acute phase of focal cerebral ischaemia.