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Case Reports
. 2011 Nov 18;1(4):e114.
doi: 10.4081/cp.2011.e114. eCollection 2011 Sep 28.

A typical example of cerebral watershed infarct

Ina Juergenson  1 , Sara Mazzucco  1 , Michele Tinazzi  1
Affiliations
Case Reports

A typical example of cerebral watershed infarct

Ina Juergenson et al. Clin Pract. .

Abstract

Watershed infarcts (WI) evolve in hemodynamic risk zones. Clinical picture of WI can be associated to partial epileptic seizures. Diffusion weighted brain magnetic resonance imaging (MRI) allows a clear diagnosis. WI pathogenesis involves either embolic or hemodynamic mechanism. A 69-year old patient presented with sub-acute occurrence of right hemiparesis and partial epileptic seizures of the right arm. Carotid ultrasounds demonstrated occlusion of the right extra-cranial internal carotid artery (ICA) and tight stenosis of the contralateral ICA. Brain Diffusion-Weighted magnetic resonance revealed acute ischemic lesions within the watershed area of the left hemisphere. Our case supports the hypothesis of impaired washout of emboli in low-perfusion brain areas as the mechanism underlying cortical WI.

Keywords: Diffusion-Weighted Magnetic Resonance.; carotid atherosclerosis; carotid ultrasounds; watershed infarct.

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Figures

Figure 1
Figure 1
Duplex scan showing (A) tight stenosis of the left extra-cranial internal carotid artery and (B) occlusion of the right internal carotid artery. Diffusion weighted brain-magnetic resonance imaging (MRI) showing watershed infarcts within the left hemisphere (C,D); MR angiography showing hypo-perfusion of the right intra-cranial internal carotid artery (E).
See this image and copyright information in PMC

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