Watershed cerebral infarctions occur at the border between cerebral vascular territories.
- prolonged hypotension: e.g cardiac surgery 5; commonly gives a bilateral pattern
- severe carotid stenosis: lesions are usually unilateral and occur on the side of the stenosis
CT and MRI
Exact pattern depends on the bordering territories.
The other (less well known) pattern is called the internal watershed, between "medullary arteries arising from the superficial pial plexus and deep penetrating arteries arising from the basal cerebral arteries" 1. The tissue at risk in this pattern is the white matter tracts of the corona radiata, and centrum semiovale. When internal infarction is confluent, then clinical outcome is poor, with only three of six patients achieved independence in one study.
- 1. Bladin CF, Chambers BR. Clinical features, pathogenesis, and computed tomographic characteristics of internal watershed infarction. Stroke. 1993;24 (12): 1925-32. Stroke (abstract) - Pubmed citation
- 2. Nakano S, Yokogami K, Ohta H et-al. CT-defined large subcortical infarcts: correlation of location with site of cerebrovascular occlusive disease. AJNR Am J Neuroradiol. 1995;16 (8): 1581-5. AJNR Am J Neuroradiol (abstract) - Pubmed citation
- 3. Momjian-mayor I, Baron JC. The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies. Stroke. 2005;36 (3): 567-77. doi:10.1161/01.STR.0000155727.82242.e1 - Pubmed citation
- 4. Moustafa RR, Izquierdo-garcia D, Jones PS et-al. Watershed infarcts in transient ischemic attack/minor stroke with > or = 50% carotid stenosis: hemodynamic or embolic? Stroke. 2010;41 (7): 1410-6. doi:10.1161/STROKEAHA.110.580415 - Pubmed citation
- 5. Gottesman RF, Sherman PM, Grega MA et-al. Watershed strokes after cardiac surgery: diagnosis, etiology, and outcome. Stroke. 2006;37 (9): 2306-11. doi:10.1161/01.STR.0000236024.68020.3a - Pubmed citation
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