| Objective:Neurological deterioration that appears within the first week following the onset of stroke is stroke in progression(SIP). It is a complex state involving many causes and mechanisms. SIP is associated with increased mortality and morbidity. Early detection and prediction of neurological deterioration, identification of the responsible mechanisms and the clinical characteristics are the basis of an effective therapy. The aim of our study is to investigate the clinical characteristics and mechanisms of SIP by comparing the SIP group with non-progression stroke group (NPS).Methods:A total of 153 patients with stroke who presented within the 24 hours of onset were enrolled. SIP was diagnosed when there was a decrease of≥2 scores in SSS from baseline to the 1-week evaluation. NPS was diagnosed when there was no decrease in SSS within the first week. The SIP and NPS stroke patients were compared in terms of their background characteristics, blood pressure, cholesterol, blood glucose, fibrinogen, body temperature, cranial CT and TCD. The 14th day and the 3～6th month function outcome were also compared.Results:(1) The overall incidence of SIP was 34.64%. 77.4% worsened during the first 24 hours after inclusion,15.1% during 24～48 hours, while 7.5% during 48～72 hours. With respect to the clinical characteristics, 92.45% appear arms or legs palsy progression, 39.62% appears consciousness disorders palsy progression, while 41.51% speech disorders worsened.⑵Hypertension differed significantly between SIP group and NPS group (P﹤0.01). In .SIP group, there were 46 cases (86.78%); In the NPS group, there were 61cases (61%). Early blood pressure descend and pulse pressure decrease also had statistical significance (P=0.000,P=0.001). In the SIP group, 15 cases (28.3%) occurs blood pressure descend, while 12 cases (22.64%) pulse pressure decrease. In the NPS group, 3 cases (3%) occurs blood pressure descend while 5 cases (5%) appears pulse pressure decrease.⑶In the SIP group ,there were 32 cases (60.38%) with hyperglycemia, including 28 (52.83%) patients with diabetes. In the NPS group, there were 40 (40%) cases with hyperglycemia, including 36 cases (36%) of diabetes. The incidence of hyperglycemia and diabetes in SIP were more frequent (P both﹤0.05).⑷Hyperthermia in the first 24 hours from the onset of stroke, in the SIP group ,there were 19 cases (35.85%). Of 19 cases, 68.42% were between 37.3～38℃, while 31.58% between 38.1～39℃.In the NPS group,5 (5%) cases occurs fever. They were all low fever. The temperature of the EPS was higher than the NPS group. And the ratio of fever differs significantly between the two groups (P﹤0.001).⑸There were no significant differences between triglyceride or cholesterol.⑹Higher FIB was more frequent in SIP group (45.28%) than in NPS group (29%).And the average of FIB between the two groups also had statistical significance,(402.75±114.06)mg/Dl(EPS) compared with (352.99±126.46) mg/dL (NPS).⑺With respect to the infarct region, in SIP group,12 (22.64%) cases with watershed were found, next to the body of lateral ventricle in 11 patients (20.75%),while the large area infarct was 16.98%. In NPS group, the numbers of the above region were respectively 11 cases (11%),5 cases (5%),10 cases (10%).They all have significant differences.⑻In SIP group, stenosis in extracranial section of the internal carotid artery were found in 9 cases (16.9%),whereas 19 cases (35.84%) were found in middle cerebral artery. In NPS group, stenosis in the above two blood vessels were respectively 7%, 22%. The two groups differed significantly(P﹤0.001). Moreover, the number of vascular involved was 1±0.98 (SIP), while 0.58±0.78 in NPS group. The difference between the two groups were significant(P﹤0.01).⑼About the prognosis, after 14 days treatment, in SIP group, the basic recover: 7.55%;notable progress: 22.64%; progress: 37.74%; no change: 24.53%; dead: 7.55%. In NPS group, the data were respectively 20%, 53%, 18%, 9%, 0%. After 3～6-month following up, the prognosis in EPS group was more worse than NPS group, comparing 8.88%, 24.44%, 42.22%, 24.44% with 26.66%, 60%, 12%, 1.33%.Conclusions:1. The frequency of SIP was 34.64%, more common within 24 hours. The clinical characteristics were more frequent in decrease of motor power.2. Hyperglycemia and hypertension were risk factors of SIP. Early descend of blood pressure and decrease of the pulse pressure could easily cause deterioration.3. The fever within 24 hours of stroke onset was predictive factors of bad prognosis and deterioration. Moreover ,the higher the temperature was, the more frequent the deterioration would be.4. FIB was an important factors of worsening.5. The infarct in watershed, body of lateral ventricle and large volume infarction were more common in SIP.6. Stenosis, especially the medium or severe stenosis of the MCA, extracranial section of the internal carotid artery was an important risk factor of SIP.7. The prognosis was worse in SIP. |
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