A cross sectional study on imaging patterns of watershed infarcts among patients admitted to a neuro care centre in costal part of Tamil Nadu

Abstract

Introduction newlineWatershed infarctions (WIs) account for up to 10% of all cerebral infarctions, with their pathogenesis remaining poorly understood. These infarctions are typically caused by embolic or hemodynamic mechanisms, or a combination of both, arising from blockages or stenosis in major cerebral arteries. Their sub-acute onset and association with partial clonic seizures often pose diagnostic challenges for clinicians. The clinical presentation of WIs is frequently variable and progressive, ranging from moderate to severe, which can occasionally lead to mismanagement. Carotid artery occlusive disorders are typically evaluated using magnetic resonance angiography (MRA) or digital subtraction angiography (DSA). However, endovascular surgery for severe atherosclerotic stenosis of cerebral arteries carries significant risks, requiring careful patient selection by highly skilled neurosurgeons. This pioneering research in the Indian population seeks to examine the baseline characteristics, clinical progression, neuroradiological features, and affected arteries in patients with WIs. Utilizing MRI and DSA, the study aims to facilitate appropriate interventions, even for patients presenting with subtle neurological symptoms. newlineAIMS AND OBJECTIVES newline To study the clinical profile of water shed infarcts. newline To assess the DWI findings and DSA findings in watershed infarcts. newline To co-relate the clinical and radiological findings in water shed infarcts newlineMaterials and methods newlineAn observational retrospective study was conducted to assess the clinical and radiological profile of Watershed Infarct patients from the Department of General Medicine, Chettinad Hospital and Research Institute from April 2021 to January 2023. They were recruited based on inclusion and exclusion criteria. Detailed history, examination, and outcome were taken from the case sheets available/telephonic newlineconversation and direct follow up. All clinical and radiological data were entered in excel sheet newlineResults and analysis newlineIn the present study, Cortical WI was observed in 38% cases, internal WI was observed in 32% cases and both cortical and internal WI were noted in 30% of cases. Hemiparesis and seizures were common presentations for cortical WI. Hemiparesis and dysarthria for internal WI. MCA was common blood vessel involved in cortical WI and ICA for Internal WI. newlineAs per NIHSS score, majority of WI fell under minor stroke and severe stroke was observed in cortical more than internal WI. Among the fifty cases, 20% of cortical WI and 10% of internal WI cases required ICU care. On assessing the outcome, 88% of cases survived and among the six cases who died, there were 3 cortical , 2 internal and 1 both cortical and internal WI patient. newlineCONCLUSION newlineIn conclusion, We infer that much attention to be paid for cases with watershed infarctions, in order to diagnose early and treat promptly, preferably in a centre with interventional neurologist so the patient can undergo DSA, which is not only diagnostic but also therapeutic, and be treated appropriately in ward or ICU setting to prevent morbidity and unnecessary mortality. newline