Middle/Anterior Cerebral Watershed Infarction - Case 3

A 78 year-old man presented with over 20 spells of transient loss of vision in the right eye. Othewise, her neurologic examination was normal.

Show the Carotid Lesion                                                                             Outline the Infarction                                                              

(Left) Right Carotid Angiogram; (Right) MRI axial diffusion weighted images. On the angiogram, note the high grade internal carotid artery stenosis. In addition, the external carotid artery is tightly occluded with a "string sign." On MRI diffusion images, there are several small infarcts which were clinically silent. All are in the distribution the watershed between the middle and anterior cerebral arteries. When a watershed infarction is seen on one side, this usually occurs due to hemodynamic narrowing of a proximal artery (e.g., in this case, the carotid artery).

04/22/06Revised 10/28/05.
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