Presentation
Right sided weakness.
Patient Data
There are multiple infarcts in the left subcortical white matter and centrum semiovale as evidenced by abnormal diffusion restriction on DWI at the border zones of the middle cerebral artery/anterior cerebral artery (MCA/ACA) and middle cerebral artery/posterior cerebral artery (MCA/PCA) territories.
Signal voids of both internal carotid arteries are intact.
Other high T2 and T2/FLAIR signal foci in the subcortical and periventricular white matter of both cerebral hemispheres are consistent with microvascular ischemic events (Fazekas III).
Prominence of the ventricular system and brain sulci depicts brain tissue volume loss (atrophy).
Case Discussion
Watershed infarcts occur at the border zones between major cerebral arterial territories as a result of hypoperfusion.
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