Watershed stroke
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A watershed stroke is a medical term describing a stroke or cerebrovascular accident (CVA) affecting areas of the brain furthest from direct perfusion with blood supply by the major cerebral arteries.
Watershed strokes result from hypoperfusion (a lack of blood flow), which can be caused by congestive heart failure, severe atherosclerosis of the carotid arteries, or systemic hypotension (shock). Because the brain's circulation is formed by small end-arteries branching from larger central blood vessels, poor perfusion of the brain most strongly affects tissues supplied by the most distal branches of these arteries, producing ischemia and infarction at the border of these "watershed" areas.
A watershed stroke in the region of overlapped distribution between the anterior cerebral artery and the middle cerebral artery classically presents with weakness of proximal arm and leg muscles and preservation of distal strength: colloquially, the "man in a barrel" presentation. This is because this particular region of the brain is responsible for such muscles. See motor homunculus.
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
