Radiologic-pathologic autopsy correlation of an internal watershed infarct, a case report

ABSTRACT Internal watershed infarcts (IWIs) occur at the junction of the deep and superficial perforating arterial branches of the cerebrum. Despite documentation in the radiology literature, IWIs are rarely encountered at the time of autopsy. Here, we report the case of a 59-year-old incarcerated male who was brought to the emergency department after being found unresponsive on the floor of his jail cell. Initial examination and imaging demonstrated right-sided hemiplegia, aphasia, right facial droop, and severe stenosis of the left middle cerebral artery, respectively. Repeat imaging 4 days after admission and 26 days before death demonstrated advanced stenosis of the intracranial, communicating segment of the right internal carotid artery, a large acute infarct in the right posterior cerebral artery territory, and bilateral deep white matter ischemic changes with a right-sided "rosary-like" pattern of injury that is typical of IWIs. Postmortem gross examination showed that the right deep white matter lesion had progressed to a confluent, "cigar-shaped" subacute IWI involving the right corona radiata. This is the first well-documented case of an IWI with radiologic imaging and photographic gross pathology correlation. This case uniquely highlights a rarely encountered lesion at the time of autopsy and provides an excellent visual representation of internal watershed neuroanatomy.

Risk factors and MRA observation in the patients with cortical watershed infarcts or internal watershed in-farcts / 实用医学杂志

Objective To investigate the risk factors and MRA manifests in the patients with cortical wa-tershed infarcts(CWSI)or internal watershed infarcts(IWSI).Methods We collected the patients with acute wa-tershed infarcts in our hospital from January 2013 to April 2016.According to the Bogousslavsky classification stan-dard,the patients were divided into two groups:CWSI and IWSI. The two groups were compared in terms of risk factors and MRA manifests. Results We included 36 CWSI and 11 IWSI patients in the study.There were signifi-cant differences in smoke,diabetes mellitus,fasting blood glucose levels and carotid atherosclerotic plaque be-tween the two groups,and so it was with the stenosis of ICA,MCA,ACA,PCA,VA and BA:The stenosis of ICA in the CWSI group was more serious than in the IWSI group,but the stenosis of MCA,ACA,PCA,VA and BA in the IWSI group was more serious than in the CWSI group. Conclusions The pathogenesis of CWSI may be related to the formation of carotid atherosclerotic plaques,carotid stenosis and arterial artery embolism,or plaque shedding and micro emboli removal.The pathogenesis of IWSI may be related to the decrease of the perfusion pres-sure at the end of the intracranial artery.The ratio of IWSI to diabetes mellitus is higher than that of CWSI,suggest-ing that the damage of diabetes to intracranial arteriole is earlier than that of intracranial and extracranial arteries.

Infarction location for predicting cerebral infarction progressive motor nerve function deficits in middle cerebral artery area / 重庆医学

Objective To investigate the correlation between the infarction location and progressive motor deficits (PMD) occurrence.Methods The patients with middle cerebral artery(MCA) infarction within 24 h of onset without thrombolytic therapy were included.The National Institutes of Health Stroke Scale(NIHSS) motor item score increase ≥2 points of the base line within 7 d after stroke onset served as the PMD diagnostic criteria.The differences in clinical and laboratory data,and infarction location were compared between the PMD group and non-PMD group.The multivariate Logistic regression analysis predicted the risk factors of PMD occurrence.Results A total 121 patients with MCA acute cerebral infarction were included in the study and divided into the PMD group (45 cases) and non-PMD group (76 cases).The internal watershed infarction occurrencerate in the PMD group was higher than that in the non-PMD group (26.7 ％ vs.5.3％,p=0.001).The occurrence rate of penetrating arterial infarction (PAI) had no statistical difference between the PMD group and non-PMD group(42.2％ vs.35.5％,P=0.463).PAI was further divided into perforating branch atheromatous disease (BAD) and lipohyalinitic degeneration (LD).The occurrence rate of BAD in the PMD group was significantly higher than that in the non-PMD group (28.9％ vs.9.2％,P=0.005).The stepwise Logistic regression analysis indicated that watershed infarction [odds ratio (OR):9.750,95 ％ confidence interval(CI):2.828-33.612,P=0.000] and BAD lesion (OR:6.036,95 ％ CI:2.119-17.190,P =0.001) were the independent risk factors contributing to PMD.Conclusion Internal watershed infarction and BAD lesion may predict the PMD occurrence.The infarct location is conducive to find the high risk population of cerebral infarction progress.