Watershed Infarction: A Review of Clinical Management
Abstract
Watershed infarction is a type of ischemic stroke which is caused by a localized occlusion of the blood vessels supplying the corticospinal tissue. The clinical presentation of watershed infarction is variable, with symptoms such as hemiparesis, sensory deficits, speech disturbances, and cognitive deficits. Treatment of watershed infarctions is largely focused on providing adequate blood supply to the affected area and protecting the surrounding tissue from further damage. This review aims to discuss the etiology, clinical presentation, diagnosis, and treatment of watershed infarctions.
Introduction
Watershed infarction is a type of ischemic stroke, which occurs when there is a localized occlusion of the blood vessels supplying the corticospinal tissue. It is also known as a cortical or borderzone infarction, and can be caused by a variety of factors such as thrombosis, embolism, or vasculitis. The most common location of watershed infarction is in the middle cerebral artery (MCA) territory, but it can also occur in the vertebrobasilar territory. The clinical presentation of watershed infarctions can be variable, and often depends on the location and extent of infarction.
Etiology
The etiology of watershed infarction is largely dependent on the underlying cause. Thrombosis is the most common cause of watershed infarction, and is typically caused by atherosclerosis of the large intracranial arteries. Embolism is another cause of watershed infarction, and is often due to a clot originating from the heart or aorta. Other causes of watershed infarction include vasculitis, trauma, and aneurysm.
Clinical Presentation
The clinical presentation of watershed infarction is variable and depends on the location and extent of infarction. Common symptoms include hemiparesis, sensory deficits, speech disturbances, and cognitive deficits. The most common symptom of watershed infarction is hemiparesis, which is usually only present on the side of the infarction. Sensory deficits, such as numbness or tingling, can also be present. Speech disturbances, such as dysarthria or aphasia, can also occur due to damage to the language centers of the brain. Cognitive deficits may also present, such as difficulty with memory, concentration, and executive functioning.
Diagnosis
The diagnosis of watershed infarction is typically made using imaging studies, such as MRI or CT scan. On MRI, watershed infarctions typically appear as hypo-intense lesions in the white matter. On CT scan, watershed infarctions may appear as hyperdense lesions in the white matter. Other tests, such as lumbar puncture and blood tests, may also be used to diagnose watershed infarction.
Treatment
Treatment of watershed infarction is largely focused on providing adequate blood supply to the affected area and protecting the surrounding tissue from further damage. Intravenous thrombolysis is the most common treatment for watershed infarction, and is usually successful in restoring blood flow to the affected area. Other treatments, such as anticoagulants or antiplatelet agents, may also be used to reduce the risk of further infarctions. In some cases, surgical intervention may also be necessary to treat the underlying cause of watershed infarction.
Conclusion
Watershed infarction is a type of ischemic stroke which is caused by a localized occlusion of the blood vessels supplying the corticospinal tissue. The clinical presentation of watershed infarction is variable, with symptoms such as hemiparesis, sensory deficits, speech disturbances, and cognitive deficits. Treatment of watershed infarctions is largely focused on providing adequate blood supply to the affected area and protecting the surrounding tissue from further damage.
References
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