Author(s): V. Selvanayaki, K. Sasikala


DOI: 10.5958/2349-2996.2020.00103.2   

Address: Dr. V. Selvanayaki1, Mrs. K. Sasikala2
1Research Supervisor, VMRF (DU), Salem.
2Ph.D Scholar, VMRF (DU), Salem.
*Corresponding Author

Published In:   Volume - 10,      Issue - 4,     Year - 2020

Watershed infarcts (WI) evolve in hemodynamic risk zones. Clinical picture of WI can be associated to partial epileptic seizures. Diffusion weighted brain magnetic resonance imaging (MRI) allows a clear diagnosis. WI pathogenesis involves either embolic or hemodynamic mechanism. A 69-year old patient presented with sub-acute occurrence of right hemiparesis and partial epileptic seizures of the right arm. Carotid ultrasounds demonstrated occlusion of the right extra-cranial internal carotid artery (ICA) and tight stenosis of the contralateral ICA. Brain Diffusion-Weighted magnetic resonance revealed acute ischemic lesions within the watershed area of the left hemisphere. Our case supports the hypothesis of impaired washout of emboli in low-perfusion brain areas as the mechanism underlying cortical WI.

Cite this article:
V. Selvanayaki, K. Sasikala. Watershed Stroke. Asian J. Nursing Education and Research. 2020; 10(4):483-486. doi: 10.5958/2349-2996.2020.00103.2

V. Selvanayaki, K. Sasikala. Watershed Stroke. Asian J. Nursing Education and Research. 2020; 10(4):483-486. doi: 10.5958/2349-2996.2020.00103.2   Available on:

1.     Porth, C.M. (2009). Pathophysiology: Concepts of Altered Health States (Eighth Edition). Philadelphia: Wolters Kluwer Health | Lippincott Williams and Wilkins. p. 1301. ISBN 978-16054-7390-1.
2.    Torvik, A. (1984). "The pathogenesis of watershed infarcts in the brain". Stroke. 15 (2): 221–3. doi:10.1161 /01.STR.15.2.221. PMID 6701929.
3.    Momjian-Mayor, I; Baron, J.C. (2005). "The Pathophysiology of Watershed Infarction in Internal Carotid Artery Disease: Review of Cerebral Perfusion Studies". Stroke. 36 (3): 567–77. doi: 10.1161/01.STR.0000155727. 82242. e1. PMID 15692123.
4.    Harbison, J.; Massey, A.; Barnett, L.; Hodge, D.; Ford, G. A. (1999). "Rapid ambulance protocol for acute stroke". The Lancet. 353 (9168): 1935. doi: 10.1016/S0140-6736(99)00966-6. PMID 10371574.
5.    Martini, F, Nath, J, Bartholomew, E 2012. "Fundamentals of Anatomy and Physiology.", p. 742-43. Pearson Education Inc, San Francisco. ISBN 9780321709332.
6.    Miklossy, J. (2003). "Cerebral hypoperfusion induces cortical watershed microinfarcts which may further aggravate cognitive decline in Alzheimer's disease". Neurological Research. 25 (6): 605–10. doi:10.1179/016164103101202048. PMID 14503014.
7.    Donnan, G.A.; Fisher, M; MacLeod, M.; Davis, S. M. (2008). "Stroke". The Lancet. 371 (9624): 1612–23. doi: 10.1016/S0140-6736(08)60694-7. PMID 18468545.
8.    Verduzco, L. A.; Nathan, D. G. (2009). "Sickle cell disease and stroke". Blood. 114 (25): 5117–25. doi: 10.1182/blood-2009-05-220921. PMID 19797523.
9.    Bladin, C. F.; Chambers, B. R.; Donnan, G. A. (1993). "Confusing stroke terminology: Watershed or borderzone infarction?". Stroke. 24 (3): 477–8. doi: 10.1161/01.STR.24.3.477. PMID 8446987.
10.    Grotta, JC; Alexandrov, AV (2001). "Preventing stroke: Is preventing microemboli enough?". Circulation. 103 (19): 2321–2. doi: 10.1161/01.CIR.103.19.2321. PMID 11352876.
11.    Bamford, J.; Sandercock, P.; Dennis, M.; Warlow, C.; Burn, J. (1991). "Classification and natural history of clinically identifiable subtypes of cerebral infarction". The Lancet. 337(8756): 1521–6. doi:10.1016/0140-6736(91)93206-O. PMID 1675378. Later publications distinguish between "syndrome" and "infarct", based on evidence from imaging. "Syndrome" may be replaced by "hemorrhage" if imaging demonstrates a bleed. See Internet Stroke Center. "Oxford Stroke Scale". Retrieved 2008-11-14.
12.    Bamford, J.M. (2000). "The Role of the Clinical Examination in the Subclassification of Stroke". Cerebrovascular Diseases. 10 (4): 2–4. doi: 10.1159/000047582. PMID 11070389.
13.    Adams, H. P.; Bendixen, B. H.; Kappelle, L. J.; Biller, J.; Love, B. B.; Gordon, D. L.; Marsh, E. E. (1993). "Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment". Stroke. 24(1): 35–41. doi: 10.1161/ 01.STR.24.1.35. PMID 7678184.
14.    Mathews, Marlon S.; Sharma, J.; Snyder, K. V.; Natarajan, S. K.; Siddiqui, A. H.; Hopkins, L. N.; Levy, E. I. (2009). "Safety, Effectiveness, and Practicality of Endovascular Therapy Within the First 3 Hours of Acute Ischemic Stroke Onset". Neurosurgery. 65 (5): 860–5, discussion 865. doi:10.1227/ 01.NEU.0000358953.19069.E5. PMID 19834397.
15.    Winter, Jackie; Hunter, S.; Sim, J.; Crome, P. (2011). Winter, Jackie (ed.). "Hands-on therapy interventions for upper limb motor dysfunction following stroke". Cochrane Database of Systematic Reviews (6): CD006609. doi: 10.1002/ 14651858.CD006609.pub2. PMC 6464865. PMID 21678359.
16.    Hoffmann, Tammy; Bennett, S.; Koh, C. L.; McKenna, K. T. (2010). Hoffmann, Tammy (ed.). "Occupational therapy for cognitive impairment in stroke patients" (PDF). Cochrane Database of Systematic Reviews (9): CD006430. doi: 10.1002/ 14651858.CD006430.pub2. PMC 6464961. PMID 20824849.
17.    Legg, L.; Drummond, A.; Leonardi-Bee, J.; Gladman, J R F; Corr, S.; Donkervoort, M.; Edmans, J.; Gilbertson, L.; et al. (2007). "Occupational therapy for patients with problems in personal activities of daily living after stroke: Systematic review of randomised trials".

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