Deep watershed cerebral infarct

Case contributed by Dr Hidayatullah Hamidi

Presentation

Known hypertensive patient presents with with altered mental status for last 3 days.

Patient Data

Age: 85 years
Gender: Male

Age related brain parenchymal involution.

No intracranial hemorrhage. 

No CT detectable territorial ischemic changes.

MRI

Multiple small T2 and FLAIR hyperintense foci oriented in a linear distribution in left frontal and parietal lobe periventricular white matter which are showing diffusion restriction, representing watershed acute ischemic infarcts in the border zone between left middle and anterior cerebral arteries.

Case Discussion

Watershed cerebral infarctions (border zone infarcts) occur at the border between cerebral vascular territories mainly in elderly.

Deep (internal) border zones infarct are mainly seen as ≥3 lesions, each ≥3 mm in diameter in a linear fashion parallel to the lateral ventricle in the centrum semiovale (Such in our case) or corona radiata, which sometimes become more confluent and band-like.

CT may fail in detection of early watershed infarcts, as in this case while diffusion weighted images are very helpul.

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Case information

rID: 56124
Published: 14th Oct 2017
Last edited: 16th Jul 2018
System: Vascular
Inclusion in quiz mode: Included
Institution: French Medical Institute for Mothers and Children

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