Abstract

BENJUMEA, Vanessa; VELEZ, Adolfo; HERNANDEZ, Olga  and  SANTIAGO URIBE, Carlos. Cerebral and cerebellar watershed infarcts associated with hemodynamic impairment: case report and literature review. Acta Neurol Colomb. [online]. 2014, vol.30, n.4, pp.342-345. ISSN 0120-8748.

A 86-year-old hypertensive woman was evaluated for 72 hours of unconsciousness after a sudden fall that was not preceded by any symptoms. Upon examination, she was hypotensive and unresponsive to pain. Brainstem reflexes were present. During hospitalization, she remained hypotensive and needing vasopressor support. After 1 month, she remained unresponsive. The MRI showed bilateral supratentorial and infratentorial accute ischemic strokes (Figure 1). The echocardiogram showed an ejection fraction of 55% and an atrial septal aneurysm with bilateral excursions of 15 mm and a patent foramen ovale of 7 mm. The doppler ultrasound of lower extremities was normal. Discussion: Watershed infarcts constitute approximately 10% of all brain infarcts. Two types are recognized: external (cortical) and internal (subcortical) and when both occur in association with bilateral, supratentorial and infratentorial infarcts, there is a higher probability of hemodynamic impairment, and the prognosis is invariably poor.

Keywords : Stroke; Watershed infarcts; Hemodynamic impairment; Cortical; Subcortical; Prognosis.

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