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A typical example of cerebral watershed infarct

Ina Juergenson1, Sara Mazzucco1, Michele Tinazzi1

  • 1Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Italy.

Clinics and Practice
|April 26, 2014
PubMed

Insights

Watershed infarcts (WI) can cause partial epileptic seizures. Impaired emboli washout in low-perfusion brain areas may explain these hemodynamic risk zone events.

Area of Science:

  • Neurology
  • Neuroimaging
  • Vascular Neurology

Background:

  • Watershed infarcts (WI) are ischemic brain lesions occurring in hemodynamic risk zones.
  • Clinical presentation of WI can include partial epileptic seizures.
  • Diffusion-weighted magnetic resonance imaging (MRI) is crucial for diagnosing WI.

Observation:

  • A 69-year-old patient presented with right-sided hemiparesis and partial epileptic seizures affecting the right arm.
  • Carotid ultrasound revealed complete occlusion of the right internal carotid artery (ICA) and significant stenosis of the left ICA.
  • Brain MRI demonstrated acute ischemic lesions in the watershed areas of the left hemisphere.

Findings:

  • The case illustrates a potential mechanism for cortical watershed infarcts.
  • The findings support the hypothesis that impaired emboli washout in hypoperfused brain regions contributes to WI pathogenesis.
  • This suggests a hemodynamic mechanism involving compromised cerebral blood flow.

Implications:

  • Understanding WI pathogenesis is vital for stroke prevention and treatment.
  • This case highlights the importance of evaluating carotid artery status in patients with specific neurological deficits.
  • Further research into emboli dynamics in low-perfusion states is warranted.
Keywords:
Diffusion-Weighted Magnetic Resonance.carotid atherosclerosiscarotid ultrasoundswatershed infarct

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