Watershed infarction on computed tomographic scan. An unreliable sign of hemodynamic stroke

We identified three patients with computed tomography-defined infarctions that were partly or exclusively located in watershed territories; clinical evaluation and cerebral angiography suggested that the infarcts were of embolic origin. In two patients, arteriography demonstrated minimal carotid plaque without evidence of significant stenosis. The third patient did have high-grade stenosis of the petrous portion of the ipsilateral internal carotid artery, but arteriography demonstrated a branch artery occlusion corresponding to the territory of the infarction. Although most authors suggest that watershed territory infarctions arise from hemodynamic events, cerebral embolization may be a common cause.