Stroke, Vol 24, 1925-1932, Copyright © 1993 by American Heart Association
CF Bladin and BR Chambers
BACKGROUND AND PURPOSE: Infarction in the internal border-zone region has
been described radiologically and pathologically. The aim of this study was
to define the clinical and pathophysiological correlates of internal
watershed infarction. METHODS: Eighteen consecutive stroke patients with
evidence of internal watershed infarction on computed tomography (CT) were
studied. RESULTS: Two CT patterns were identified: 6 patients had confluent
internal watershed infarction (CIWI), and 12 patients had partial internal
watershed infarction (PIWI). Syncopal symptoms and/or documented
hypotension were prominent in both groups. Patients with CIWI usually
presented with stepwise onset of contralateral hemiplegia and recovered
poorly; patients with PIWI usually had discrete episodes of brachiofacial
sensorimotor deficit and good recovery. Both groups had evidence of
cortical involvement as part of their clinical deficit. Severe carotid
occlusive disease was seen in 10 patients, and 12 patients had evidence of
transiently impaired cardiac output. Carotid disease (P < .001), cardiac
disease (P < .01), and diabetes mellitus (P < .01) were more
prevalent in patients with internal watershed infarction compared with our
stroke population as a whole. CONCLUSIONS: Distinguishing internal
watershed infarction from lacunar and other subcortical infarctions is
important because the different pathological mechanisms demand different
therapeutic strategies.
ARTICLES
Clinical features, pathogenesis, and computed tomographic characteristics of internal watershed infarction
Department of Neurology, University of Melbourne, Heidelberg Repatriation Hospital, Australia.
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