Ischemic stroke is characterized by a complex cascade of events starting from vessel occlusion. The term “penumbra” denotes the area of severely hypo-perfused brain tissue surrounding the ischemic core that can be potentially recovered if blood flow is reestablished. From the neurophysiological perspective, there are local alterations—reflecting the loss of function of the core and the penumbra—and widespread changes in neural networks functioning, since structural and functional connectivity is disrupted. These dynamic changes are closely related to blood flow in the affected area. However, the pathological process of stroke does not end after the acute phase, but it determines a long-term cascade of events, including changes of cortical excitability, that are quite precocious and might precede clinical evolution. Neurophysiological tools—such as Transcranial Magnetic Stimulation (TMS) or Electroencephalography (EEG)—have enough time resolution to efficiently reflect the pathological changes occurring after stroke. Even if they do not have a role in acute stroke management, EEG and TMS might be helpful for monitoring ischemia evolution—also in the sub-acute and chronic stages. The present review aims to describe the changes occurring in the infarcted area after stroke from the neurophysiological perspective, starting from the acute to the chronic phase.

Background: Commercially available health devices are always more common and represent a unique chance to monitor patients for prolonged periods. This study aimed to test the feasibility of a smart device-based secondary prevention program in a cohort of patients with undetermined aetiology cerebrovascular disease.Methods: Patients with non-disabling ischemic stroke and transient ischemic attack in the subacute phase were provided with a smartwatch and smart-devices to monitor various vital parameters for a 4-week period (watch group). This group was compared with a standard-of-care group. This clinical trial was registered with ClinicalTrials.gov, ID: NCT04282993.Results: In total, 161 patients were recruited, 87 in the Watch group and 74 in the control group. In the watch group, more than 90% of patients recorded the ECG at least once a day. In total, 5335 ECGs were recorded during the study. The median value of blood pressure measurements was 132 over 78 mmHg. The median oxygen saturation value was 97 %. From a clinical standpoint, nine AF episodes (10,3%) in the Watch group – vs 3 (4%) in the control group - were detected.Conclusion: Our study suggests that prevention programs for cerebrovascular disease may benefit from the implementation of new technologies.

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