Stroke - in - Progression 729

Abstract

THE TERM, ATTACKS IN PROGRESSION, is immediately attractive for clinicians since it implies action, i.e. counter-attacks, that might stop or reverse cerebral disorders. The concept of stroke-in-evolution (synonyms: stroke-in-progression, progressing stroke) is now 30 years oldbut, judging from the relevant literature, it has generated very few studies (v. infra). There are, of course, understandable reasons for a discrepancy between a prima facie strong appeal and limited success in achieving the goal. First, it may be presumed that in many places many stroke cases referred to hospitals are admitted only late in the course of the disorder, after the time when a progressing course could have been witnessed. Second, many stroke cases are admitted to non-neurological departments where a careful record of on-going events and appropriate investigations are less likely to take place. After all, keeping accurate records in a progressing stroke is an exacting task, one which requires a large amount of round-the-clock work from stroke-oriented clinicians. It may be difficult even in Neurological Departments to meet these requirements and Stroke Units where this could be best done are still few in number. Even taking the foregoing into account, there are yet other reasons for the stagnation of the concept of stroke-in-evolution. To categorize a stroke as one in progression the following questions must be answered: I) is this stroke a stroke-in-progression (starting diagnosis)?; 2) is this stroke no longer a stroke-in-progression (end diagnosis)? Obviously, such answers rest on a definition that provides the clinician with clear and non-ambiguous guidelines for making such categorizations. Unfortunately, it has been widely recognized, even by its proponents, that the definition lacks clarity, has been imprecisely described, is obscure when compared with transient ischemic attacks and is a subject that should be clearly defined as soon as possible. Recently, a different and radical blow against strokein-evolution has been struck by the proposition to waive the concept entirely. According to this view, stroke-in-evolution (together with RIND, partial non progressing stroke and completed stroke) is a product of another era, with little if any utility to its continued use. Thus, prior to examining further the merits and flaws of stroke-in-evolution it must be asked whether it is really an obsolete idea. A simple approach to this question is to ask about its place in clinical practice. Few doubt that such cases exist. Well before the term, progressing stroke, and its synonyms were created, strokes that failed to come to completion abruptly were

Cite this paper

@inproceedings{Gautier2005StrokeI, title={Stroke - in - Progression 729}, author={Jacqueline Gautier}, year={2005} }