Diagnosis: ACA MCA Watershed Territory Infarcts on MRI DWI Sequence
Findings on Imaging:
- MRI of the brain with diffusion-weighted imaging (DWI) shows hyperintense lesions in the watershed region between the anterior cerebral artery (ACA) and middle cerebral artery (MCA) territories.
- The lesions are located in the parietal and frontal lobes bilaterally, consistent with ACA MCA watershed infarcts.
- No evidence of acute intracranial hemorrhage or other focal lesions is seen on MRI.
Next Steps in Management:
- The treatment of ACA MCA watershed infarcts depends on the extent and severity of the infarcts, as well as the patient’s overall health and risk factors for stroke.
- Treatment may include blood pressure control, antiplatelet or anticoagulation therapy, and management of comorbidities.
- Rehabilitation and physical therapy may also be necessary to address any residual deficits.
Key Take Away Points:
- ACA MCA watershed infarcts occur in the border zones between the ACA and MCA territories, which are vulnerable to hypoperfusion and subsequent infarction.
- Imaging with MRI and DWI sequence can help confirm the diagnosis of ACA MCA watershed infarcts and determine the extent and severity of the infarcts.
- Treatment of ACA MCA watershed infarcts includes management of blood pressure, antiplatelet or anticoagulation therapy, and rehabilitation to address any residual deficits.
- Prevention and management of risk factors for stroke, such as hypertension and diabetes, is key to reducing the risk of ACA MCA watershed infarcts and other types of stroke.
Case Credit: Images submitted by Dr. Matthew Flores MD
