Watershed (borderzone) infarcts

Case contributed by Dr Naushad Ali Basheer Ahamed

Presentation

The patient is an 8 month old girl, a known case of sickle cell anaemia who presented with sickle cell crisis, loss of consciousness and severe shortness of breath. Patient started to develop tonic clonic convulsion which were focally localised mainly to the right arm with associated up-rolling of eyes. CT of the brain was unremarkable.

Patient Data

Age: 8 months
Gender: Female
MRI

There are multiple bilateral near symmetrical foci of restricted diffusion (appearing hyperintense on DWI with corresponding ADC images showing dark signal) seen in both cerebral hemispheres seen involving the deep white matter and sub-cortical white matter. There is no perilesional oedema.

No large territorial infarctions.

No gyral swelling or sulcal effacement.

Case Discussion

Case courtesy Dr. Ahmed Ajamy Elsayed

Watershed infarctions typically occur at the junctional zones or border zone of the arterial territories due to reduced cerebral perfusion of variable aetiologies.

  1. external or Cortical water shed infarcts: these are the more common ( and widely published ) variety of water shed infarction. These are seen at the junction of the major arterial territories, most commonly between the anterior cerebral artery (ACA) - middle cerebral artery (MCA) and middle cerebral artery (MCA) – posterior cerebral artery (PCA). These are seen as larger confluent white matter hyper-intensities on T2 weighted MR images and are usually wedge shaped or oval in shape
  2. internal watershed infarcts: these are relatively smaller foci of restricted diffusion seen symmetrically in both cerebral hemispheres, in the deep white matter, sub-cortical white matter and in the basal ganglia region in particular in the zone of the lenticulostriate perforator circulation
PlayAdd to Share

Case information

rID: 23286
Case created: 2nd Jun 2013
Last edited: 26th Sep 2015
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.