BORDER ZONE INFARCTS: A PICTORIAL REVIEW

Amna Alvi, Fatima Mubarak, Asma Alvi

Abstract


Border zone or watershed infarcts are ischemic lesions that occur at the junction of  two non anastomosing major cerebral arterial territories, constituting approximately 10% of all brain in­farcts. Two types of border zone infarcts (BZI) are recognized: Supra tentorial and infra tentorial. Supra tentorial BZI are further of two types; external (cortical) and internal (subcortical). Their pathophysiology has not yet been fully elucidated, but a commonly accepted hypothesis holds that in­ternal BZI are caused mainly by hemodynamic com­promise, whereas external BZI are believed to result from embolism but not always with associated hypoperfusion. Various imaging modalities have been used to determine the presence and ex­tent of hemodynamic compromise or misery perfusion in association with BZI. Several advanced techniques (e-g, diffusion and perfusion magnetic resonance imaging and computed tomography, positron emission tomography) can be useful for identifying the pathophysiology, making an early clinical diagnosis and predicting the outcome.



Full Text:

PDF

References


REFERENCES ACCORDING TO ARTICLES NO:

Mangla R, Kolar B, Almast J, Ekholm SE. Border zone infarcts: pathophysiologic and imaging characteristics. Radiographics. 2011 Sep 6;31(5):1201-14.

Joinlambert C, Saliou G, Flamand-Roze C, Masnou P, Sarov M, Souillard R, Saliou-Théaudin M, Guedj T, Assayag P, Ducreux D, Adams D. Cortical border-zone infarcts: clinical features, causes and outcome. Journal of Neurology, Neurosurgery & Psychiatry. 2012 Aug 1;83(8):771-5.

Cauquil-Michon C, Flamand-Roze C, Denier C. Borderzone strokes and transcortical aphasia. Current neurology and neuroscience reports. 2011 Dec 1;11(6):570-7.

Chen H, Hong H, Liu D, Xu G, Wang Y, Zeng J, Zhang R, Liu X. Lesion patterns and mechanism of cerebral infarction caused by severe atherosclerotic intracranial internal carotid artery stenosis. Journal of the neurological sciences. 2011 Aug 15;307(1):79-85.

Jean-Baptiste E, Perini P, Suissa L, Lachaud S, Declemy S, Mahagne MH, Mousnier A, Hassen-Khodja R. Prognostic value of preoperative border-zone (watershed) infarcts on the early postoperative outcomes of carotid endarterectomy after acute ischemic stroke. European Journal of Vascular and Endovascular Surgery. 2013 Mar 31;45(3):210-7.

Miklossy J. Cerebral hypoperfusion induces cortical watershed microinfarcts which may further aggravate cognitive decline in Alzheimer's disease. Neurological research. 2013 Jul 19.

d'Esterre CD. Improving Acute Stroke Management with CT Perfusion Imaging: Approaches to Treatment Guidance and Brain Tissue Salvage.

Denier C, Masnou P, Mapoure Y, Souillard-Scemama R, Guedj T, Théaudin M, Fagniez O, Join-Lambert C, Lozeron P, Ducot B, Ducreux D. Watershed infarctions are more prone than other cortical infarcts to cause early-onset seizures. Archives of neurology. 2010 Oct 11;67(10):1219-23.

Yano C, Iwata M, Uchiyama S. Risk factors for small cortical infarction on diffusion-weighted magnetic resonance imaging in patients with acute ischemic stroke. Journal of Stroke and Cerebrovascular Diseases. 2011 Feb 28;20(1):68-74.

Bergui M, Castagno D, D’Agata F, Cicerale A, Anselmino M, Ferrio FM, Giustetto C, Halimi F, Scaglione M, Gaita F. Selective Vulnerability of Cortical Border Zone to Microembolic Infarct. Stroke. 2015 Jul 1;46(7):1864-9.

Klijn CJ, Kappelle LJ. Haemodynamic stroke: clinical features, prognosis, and management. The Lancet Neurology. 2010 Oct 31;9(10):1008-17.

Moustafa RR, Izquierdo-Garcia D, Jones PS, Graves MJ, Fryer TD, Gillard JH, Warburton EA, Baron JC. Watershed Infarcts in Transient Ischemic Attack/Minor Stroke With≥ 50% Carotid Stenosis Hemodynamic or Embolic?. Stroke. 2010 Jul 1;41(7):1410-6.

Howard RS, Holmes PA, Siddiqui A, Treacher D, Tsiropoulos I, Koutroumanidis M. Hypoxic–ischaemic brain injury: imaging and neurophysiology abnormalities related to outcome. QJM. 2012 Feb 9:hcs016.

Yamauchi H, Higashi T, Kagawa S, Nishii R, Kudo T, Sugimoto K, Okazawa H, Fukuyama H. Is misery perfusion still a predictor of stroke in symptomatic major cerebral artery disease?. Brain. 2012 Aug 1;135(8):2515-26.

Zhang Z, Xiao M, Ye Z, Zhang W, Han B, Li Y. Noncardiogenic Stroke Patients with Metabolic Syndrome Have More Border-zone Infarction and Intracranial Artery Stenosis. Journal of Stroke and Cerebrovascular Diseases. 2015 Mar 31;24(3):629-34.

Kanekar SG, Zacharia T, Roller R. Imaging of stroke: Part 2, Pathophysiology at the molecular and cellular levels and corresponding imaging changes. American Journal of Roentgenology. 2012 Jan;198(1):63-74.

Chen W, Fang J, Dong YR, Di Y, Li W. Teaching NeuroImages: Isolated vertigo and imbalance due to deep border zone cerebellar infarct. Neurology. 2011 Nov 22;77(21):e122.

Lakhan SE, Avramut M, Tepper SJ. Structural and functional neuroimaging in migraine: insights from 3 decades of research. Headache: The Journal of Head and Face Pain. 2013 Jan 1;53(1):46-66.

Numata Y, Onuma A, Kobayashi Y, SATO‐SHIRAI IK, Tanaka S, Kobayashi S, Wakusawa K, Inui T, Kure S, Haginoya K. Brain magnetic resonance imaging and motor and intellectual functioning in 86 patients born at term with spastic diplegia. Developmental Medicine & Child Neurology. 2013 Feb 1;55(2):167-72.

Detre JA, Rao H, Wang DJ, Chen YF, Wang Z. Applications of arterial spin labeled MRI in the brain. Journal of Magnetic Resonance Imaging. 2012 May 1;35(5):1026-37.


Refbacks

  • There are currently no refbacks.


© Copyright PJR 2008-