Clinical and Imaging Analysis of a Cerebellar Watershed Infarction


Objective: To investigate the characteristics of vascular lesions in patients with a cerebellar watershed infarction. Methods: Clinical data from 178 cases of cerebellar infarction were collected with magnetic resonance imaging (MRI) scan results, including diffusion weighted imaging (DWI), a magnetic resonance angiography (MRA), and computed tomography angiography (CTA). The cases were divided into cerebellar watershed and non-watershed infarctions based on lesion location, which was revealed by DWI. Forty-two cases met the criteria for a cerebellar watershed infarction. Based on the MRA/CTA results, the vertebrobasilar artery stenoses were divided into four categories (i.e., intracranial, extracranial, combined, and no detectable stenosis) to compare the vascular lesion characteristics from patients with a cerebellar watershed infarction and patients with a non-watershed infarction. Results: Patients with cerebellar watershed infarcts presented mild symptoms at onset and had a favorable prognosis. However, 90.5% of these patients had a vascular stenosis, which was higher than for patients with a cerebellar non-watershed infarction (74.3%). The four types of vascular lesions, intracranial, extracranial, combined, and no detectable stenosis, were 14.3%, 52.4%, 23.8%, and 9.5% in patients with a cerebellar watershed infarction and 33.8%, 16.2%, 24.3%, and 25.7% in patients with a non-watershed cerebellar infarction, respectively. Conclusion: Although patients with cerebellar watershed infarcts often had comparatively benign clinical manifestations and prognoses, such patients also had a high stenosis prevalence in major blood vessels, especially the extracranial segment in the vertebral artery, which required early intervention and treatment.

Share and Cite:

Zheng, M. , Sun, A. , Sun, Q. , Zhang, H. and Fan, D. (2015) Clinical and Imaging Analysis of a Cerebellar Watershed Infarction. Chinese Medicine, 6, 54-60. doi: 10.4236/cm.2015.61006.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Amarenco, P., Kase, C.S., Rosengart, A., et al. (1993) Very Small (Border Zone) Cerebellar Infarcts. Distribution, Causes, Mechanisms and Clinical Features. Brain, 116, 161-186.
[2] De Cocker, L.J., van Veluw, S.J., Fowkes, M., et al. (2013) Very Small Cerebellar Infarcts: Integration of Recent Insights into a Functional Topographic Classification. Cerebrovascular Diseases, 36, 81-87.
[3] Neurology Branch of Cerebrovascular Treatment Guidelines in Group of Acute Ischemic Stroke Writing Group of Chinese Medical Association (2010) China Guideline for Diagnosis and Treatment of Acute Ischemic Stroke. Chinese Journal of Neurology, 43, 146-153.
[4] Mangla, R., Kolar, B., Almast, J., et al. (2011) Border Zone Infarcts: Pathophysiologic and Imaging Characteristics. Radiographics, 31, 1201-1214.
[5] Moustafa, R.R., Izquierdo-Garcia, D., Jones, P.S., et al. (2010) Watershed Infarcts in Transient Ischemic Attack/Minor Stroke with > or = 50% Carotid Stenosis: Hemodynamic or Embolic? Stroke, 41, 1410-1416.
[6] Momjian-Mayor, I. and Baron, J.C. (2005) The Pathophysiology of Watershed Infarction in Internal Carotid Artery Disease: Review of Cerebral Perfusion Studies. Stroke, 36, 567-577.
[7] Stump, D.A., Rogers, A.T., Hammon, J.W., et al. (1996) Cerebral Emboli and Cognitive Outcome after Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 10, 113-118.
[8] Bladin, C.F. and Chambers, B.R. (1994) Frequency and Pathogenesis of Hemodynamic Stroke. Stroke, 25, 2179-2182.
[9] Masuda, J., Yutani, C., Ogata, J., et al. (1994) Atheromatous Embolism in the Brain: A Clinicopathologic Analysis of 15 Autopsy Cases. Neurology, 44, 1231-1237.
[10] Wong, K.S., Gao, S., Chan, Y.L., et al. (2002) Mechanisms of Acute Cerebral Infarctions in Patients with Middle Cerebral Artery Stenosis: A Diffusion-Weighted Imaging and Microemboli Monitoring Study. Annals of Neurology, 52, 74-81.
[11] Caplan, L.R. and Hennerici, M. (1998) Impaired Clearance of Emboli (Washout) Is an Important Link between Hypoperfusion, Embolism, and Ischemic Stroke. Archives of Neurology, 55, 1475-1482.
[12] Moriwaki, H., Matsumoto, M., Hashikawa, K., et al. (1997) Hemodynamic Aspect of Cerebral Watershed Infarction: Assessment of Perfusion Reserve Using Iodine-123-Iodoamphetamine SPECT. Journal of Nuclear Medicine, 38, 1556-1562.
[13] Lee, P.H., Bang, O.Y., Oh, S.H., et al. (2003) Subcortical White Matter Infarcts: Comparison of Superficial Perforating Artery and Internal Border-Zone Infarcts Using Diffusion-Weighted Magnetic Resonance Imaging. Stroke, 34, 2630-2635.
[14] Yong, S.W., Bang, O.Y., Lee, P.H., et al. (2006) Internal and Cortical Border-Zone Infarction: Clinical and Diffusion-Weighted Imaging Features. Stroke, 37, 841-846.

Copyright © 2023 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.