What are watershed infarctions in stroke?

Updated: Nov 30, 2018
  • Author: Andrew Danziger; Chief Editor: L Gill Naul, MD  more...
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Vascular watershed or border-zone infarctions occur at the most distal areas between arterial territories (see the image below). They are believed to be secondary to embolic phenomenon or due to severe hypoperfusion, such as in carotid occlusion or prolonged hypotension. [21, 22]

MRI was obtained to evaluate this 62-year-old hype MRI was obtained to evaluate this 62-year-old hypertensive and diabetic male with history of transient episodes of right-sided weakness and aphasia. The FLAIR image (left) demonstrates patchy areas of high signal arranged in a linear fashion in the deep white matter, bilaterally. This configuration is typical for deep borderzone or watershed infarction; in this case, the anterior and posterior middle cerebral artery (MCA) watershed areas. The left-sided infarcts have corresponding low signal on the ADC map (right), signifying acuity. An old left posterior parietal infarct is noted as well.

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