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(Stroke. 2002;33:1986.)
© 2002 American Heart Association, Inc.

Original Contributions

Cerebral Hypoperfusion Generates Cortical Watershed Microinfarcts in Alzheimer Disease

Oda-Christina Suter, MD; Thanomphone Sunthorn; Rudolf Kraftsik; Joel Straubel; Pushpa Darekar, BSc; Kamel Khalili, PhD Judith Miklossy, MD

From the University Institute of Pathology, Division of Neuropathology, University Medical School (O-C.S., T.S., J.S., P.D., J.M.), and Institute of Cellular Biology and Morphology, University of Lausanne (R.K.), Lausanne, Switzerland; and Center for Neurovirology and Cancer Biology, College of Science and Technology, Temple University, Philadelphia, Pa (K.K., J.M.).

Correspondence to Judith Miklossy, MD, Center for Neurovirology and Cancer Biology, College of Science and Technology, Temple University, 1900 N 12th St, Philadelphia, PA 19122. E-mail miklossy{at}astro.temple.edu

Background and Purpose— The watershed cortical areas are the first to be deprived of sufficient blood flow in the event of cerebral hypoperfusion and will be the sites of watershed microinfarcts. Cerebral hypoperfusion is associated with Alzheimer disease (AD), but information regarding the occurrence of watershed cortical infarcts in AD is lacking.

Methods— Brains of 184 autopsy cases (105 definite AD cases and 79 age-matched controls) were selected and analyzed by histochemical and immunohistochemical techniques. The 3-dimensional reconstruction of the whole cerebrum, with 3-mm spaced serial sections, was performed in 6 AD cases to study the intrahemispheric and interhemispheric distribution of the cortical microinfarcts.

Results— A significant association (P=0.001) was found between the occurrence of watershed cortical infarcts and AD (32.4% versus 2.5% in controls). The microinfarcts were restricted to the watershed cortical zones. Congophilic angiopathy was revealed to be an important risk factor. Perturbed hemodynamic factors (eg, decreased blood pressure) may play a role in the genesis of cortical watershed microinfarcts.

Conclusions— In AD, cerebral hypoperfusion induces not only white matter changes but cortical watershed microinfarcts as well, further aggravating the degenerative process and worsening dementia. To prevent the formation of watershed cortical microinfarcts in AD, monitoring blood pressure and treating arterial hypotension are essential.

Key Words: Alzheimer disease • amyloid • angiopathy • cerebral infarction • hypoperfusion

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