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Watershed Infarction - Case 1

A 65 year-old man was found confused and unable to see following a cardiac arrest. On exam he had prominent weakness of both shoulder and hip girdle muscles.

Outline the Infarctions and Show the Vascular Territories

Axial Flair MRI scan - note the bilateral area of infarction. The most prominent are in the posterior areas in the watershed between the middle and posterior cerebral arteries. However, on the two scans on the right, note there is also infarctions anteriorly between the territories of the anterior and middle cerebral arteries. The anterior watershed area results in weakness of the hip and shoulder girdle muscles (i.e., man in the barrel) whereas the posterior watershed results in visual abnormalities.

Revised 04/23/06.
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