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Radiologic-pathologic autopsy correlation of an internal watershed infarct, a case report

Internal watershed infarcts (IWIs) occur at the junction of the deep and superficial perforating arterial branches of the cerebrum. Despite documentation in the radiology literature, IWIs are rarely encountered at the time of autopsy. Here, we report the case of a 59-year-old incarcerated male who w...

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Autores principales: Zaikos, Thomas Dimitrios, Yousem, David M., Troncoso, Juan C., Nix, James Stephen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hospital Universitário da Universidade de São Paulo 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10687791/
https://www.ncbi.nlm.nih.gov/pubmed/38034516
http://dx.doi.org/10.4322/acr.2023.448
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author Zaikos, Thomas Dimitrios
Yousem, David M.
Troncoso, Juan C.
Nix, James Stephen
author_facet Zaikos, Thomas Dimitrios
Yousem, David M.
Troncoso, Juan C.
Nix, James Stephen
author_sort Zaikos, Thomas Dimitrios
collection PubMed
description Internal watershed infarcts (IWIs) occur at the junction of the deep and superficial perforating arterial branches of the cerebrum. Despite documentation in the radiology literature, IWIs are rarely encountered at the time of autopsy. Here, we report the case of a 59-year-old incarcerated male who was brought to the emergency department after being found unresponsive on the floor of his jail cell. Initial examination and imaging demonstrated right-sided hemiplegia, aphasia, right facial droop, and severe stenosis of the left middle cerebral artery, respectively. Repeat imaging 4 days after admission and 26 days before death demonstrated advanced stenosis of the intracranial, communicating segment of the right internal carotid artery, a large acute infarct in the right posterior cerebral artery territory, and bilateral deep white matter ischemic changes with a right-sided “rosary-like” pattern of injury that is typical of IWIs. Postmortem gross examination showed that the right deep white matter lesion had progressed to a confluent, “cigar-shaped” subacute IWI involving the right corona radiata. This is the first well-documented case of an IWI with radiologic imaging and photographic gross pathology correlation. This case uniquely highlights a rarely encountered lesion at the time of autopsy and provides an excellent visual representation of internal watershed neuroanatomy.
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spelling pubmed-106877912023-11-30 Radiologic-pathologic autopsy correlation of an internal watershed infarct, a case report Zaikos, Thomas Dimitrios Yousem, David M. Troncoso, Juan C. Nix, James Stephen Autops Case Rep Autopsy Case Report Internal watershed infarcts (IWIs) occur at the junction of the deep and superficial perforating arterial branches of the cerebrum. Despite documentation in the radiology literature, IWIs are rarely encountered at the time of autopsy. Here, we report the case of a 59-year-old incarcerated male who was brought to the emergency department after being found unresponsive on the floor of his jail cell. Initial examination and imaging demonstrated right-sided hemiplegia, aphasia, right facial droop, and severe stenosis of the left middle cerebral artery, respectively. Repeat imaging 4 days after admission and 26 days before death demonstrated advanced stenosis of the intracranial, communicating segment of the right internal carotid artery, a large acute infarct in the right posterior cerebral artery territory, and bilateral deep white matter ischemic changes with a right-sided “rosary-like” pattern of injury that is typical of IWIs. Postmortem gross examination showed that the right deep white matter lesion had progressed to a confluent, “cigar-shaped” subacute IWI involving the right corona radiata. This is the first well-documented case of an IWI with radiologic imaging and photographic gross pathology correlation. This case uniquely highlights a rarely encountered lesion at the time of autopsy and provides an excellent visual representation of internal watershed neuroanatomy. Hospital Universitário da Universidade de São Paulo 2023-10-23 /pmc/articles/PMC10687791/ /pubmed/38034516 http://dx.doi.org/10.4322/acr.2023.448 Text en Copyright: © 2023 The Authors. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Autopsy Case Report
Zaikos, Thomas Dimitrios
Yousem, David M.
Troncoso, Juan C.
Nix, James Stephen
Radiologic-pathologic autopsy correlation of an internal watershed infarct, a case report
title Radiologic-pathologic autopsy correlation of an internal watershed infarct, a case report
title_full Radiologic-pathologic autopsy correlation of an internal watershed infarct, a case report
title_fullStr Radiologic-pathologic autopsy correlation of an internal watershed infarct, a case report
title_full_unstemmed Radiologic-pathologic autopsy correlation of an internal watershed infarct, a case report
title_short Radiologic-pathologic autopsy correlation of an internal watershed infarct, a case report
title_sort radiologic-pathologic autopsy correlation of an internal watershed infarct, a case report
topic Autopsy Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10687791/
https://www.ncbi.nlm.nih.gov/pubmed/38034516
http://dx.doi.org/10.4322/acr.2023.448
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