Hemodynamic causes of deterioration in acute ischemic stroke

Neurological deterioration can occur in 13–38% of patients with acute ischemic stroke due to hemodynamic and non-hemodynamic causes. Several non-hemodynamic mechanisms can lead to ischemic lesion extension and subsequent neurological worsening, including infections, cerebral edema, hemorrhagic conversion of infarction and metabolic disorders. The most common hemodynamic causes related to infarct expansion, leading to neurologic deterioration in the setting of acute cerebral ischemia are the following: (i) cardiac complications, (ii) arterial reocclusion, (iii) intracranial arterial steal phenomenon, and (iv) cerebral microembolization. The present review aims to address the underlying mechanisms and potential clinical implications of the hemodynamic causes of neurological deterioration in patients with acute cerebral ischemia. The contribution of neurosonology in detection of changes in cerebral hemodynamics in real-time are also going to be discussed. Finally, potential treatment strategies for specific causes of hemodynamic deterioration in acute ischemic stroke patients are reported.