Progressive cerebral infarction refers to the stage or progressive worsening of cerebral infarction during conventional antithrombotic therapy, and it continues to progress within 48 hours or a week. It is a complex pathological state involving multiple causes and mechanisms, with poor clinical outcomes and higher rates of death and disability than ordinary cerebral infarction. Therefore, it is necessary to master its clinical characteristics, identify and establish risk factors, and give targeted treatment is the key to successful treatment. Xie Jianjun, Department of Geriatrics, Yanjiao People’s Hospital 1. Elevated blood glucose level in the acute stage: elevated blood glucose in the acute stage increases anaerobic glycolysis, causing lactic acid accumulation in brain cells, aggravating acidosis of ischemic hemipelagic cells, causing mitochondrial damage to brain cells and eventually brain cell death. At the same time, elevated blood glucose can intensify the hypercoagulable state of blood, leading to the slowing down of intravascular blood flow, increasing the area of ischemic infarction, intensifying cerebral edema, and continuing progressive aggravation of the disease. Insulin should be used as early as possible to control hyperglycemia in the acute phase. In diabetic patients, it is recommended to control blood glucose at 7.0 mmol/L fasting and 10 mmol/L after meal, while in non-diabetic patients, it is sufficient to control blood glucose level at normal standard. 2. Excessive decrease of blood pressure of medical origin: early cerebral infarction often has elevated blood pressure, which is the stress response of the body to cerebral ischemia and can increase the blood flow of collateral circulation, which is conducive to self-regulation. The tolerance of acute cerebral infarction to hypotension is reduced, and the blood pressure can be lowered to a certain degree to make the collateral circulation relatively insufficient and the cerebral perfusion poor, and excessive hypotension makes the ischemic semidark zone expand leading to the deterioration of infarction. Therefore, the blood pressure should not be lowered excessively in the acute stage, and should be treated only when the mean arterial pressure is greater than 130 mmHg. 3. Ischemic hypoperfusion: Ischemic hypoperfusion is an important cause of the progression of acute cerebral infarction. Cerebral angiography shows that some cerebral infarcts have severe atherosclerotic stenosis of intracranial vessels. Blood perfusion in the infarcted area decreases, poor collateral circulation blood velocity slows down, and ischemia and hypoxia can enlarge the ischemic semidark zone and worsen cerebral infarction. Clinical summary found that volume expansion therapy can make some patients with hypoperfusion significantly improve their symptoms.