A flexible and operational definition of progressive stroke was introduced by the EPSS (EuropeanProgressingStrokeStudyGroup) in 2003 and validated by an observational study from 10 centers of the ESDS (EuropeanstrokeDatabaseCollaboration) [1]. This assessment procedure is based on five key neurological clinical manifestations using the SSS (ScandinavianStrokeScale) scoring system; at fixed intervals, caregivers on the stroke unit repeat the assessment procedure to define whether it is EDE or SP [1]. Compared with other definitions, the EPSS definition is well structured and valid for determining prognosis, and can serve as a standard for the study of the etiology and pathogenesis of this common and important phenomenon, as follows:
SNOBS(StandardisedNursingObservationsforStroke) from the clinical manifestations of SSS are shown in Table
Table: SSS (ScandinavianStrokeScale) score
____________________________________________________________
Assessment content
SSS score
Upper limb movement
Score 0 = paralysis;
2 points = able to move, but unable to resist gravity;
4 points = flexion of the elbow joint to lift the arm;
5 points = able to lift the arm, but with weak strength;
6 points = normal
Lower extremity movement
0 points = paralysis;
2 points = able to move, but unable to resist gravity;
4 points = knee flexion to lift the leg;
5 points = able to lift the leg, but with weak strength;
6 points = normal
Eye movements
0 points = eyes are biased towards gaze;
2 points = lateral gaze paralysis;
4 minutes = normal;
Aqueous Consciousness
0 points = unconscious, unresponsive to speech;
2 points=responsive to verbal commands, but not fully aroused;
4 points = drowsy, but can be fully awakened;
6 points = fully awake
Language function
0 points = only “yes or no” or less;
3 points = more than “yes or no”, but no long sentences;
6 points = limited vocabulary or incoherent speech;
10 points = no lapses in speech
____________________________________________________________
General progressive stroke is defined as a stroke that is aggravated by treatment within 1 week of onset, and can be classified as early progressive, with an aggravation of greater than or equal to 2 points in any 1 of consciousness level, upper and lower limb movements, and eye movements and/or an aggravation of greater than or equal to 3 points in speech function, assessed within 3 d of onset, and with 2 definitions:
(1) EDE (EarlyDeteriorationEpisode) definition, i.e., an exacerbation of greater than or equal to 2 points in any one of the levels of consciousness, upper and lower limb movements, and eye movements and/or an exacerbation of greater than or equal to 3 points in speech function at any 2 consecutive assessments within the first 3 d of onset;
(2) SP (StrokeProgression) defined as having a progressive exacerbation of ditto neurological damage or death when comparing the 3rd d of onset with the 1st d assessment (baseline assessment within 24 h of onset). Late progression is assessed in the 3d to 1 week of onset with progressive exacerbation of ditto neurological damage; usually SP refers to within the first 3d of onset [1].