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A 74 year-old man was agitated upon awakening from CABG surgery. On exam he had prominent weakness of both shoulder and hip girdle muscles and cortical blindness.
Axial CT scan - note the bilateral area of infarction in the watershed between the anterior and middle, and middle and posterior 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. This pattern is classically seen following global hypoperfusion.(ACA = anterior cerebral artery; MCA = middle cerebral artery; PCA = posterior cerebral artery).
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