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Watershed infarction — SCE Neurology MCQ

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ModerateStrokeWatershed infarctionSCE Neurology

A 18-year-old woman presented with bilateral proximal arm weakness after prolonged hypotension during sepsis. On examination, legs were relatively spared and cognition was intact. Initial investigations showed: MRI showed bilateral border-zone infarcts between ACA and MCA territories. What is the most likely diagnosis?

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Correct answer: B — Watershed infarction

Watershed infarction is the best answer because the vignette describes Watershed infarction: man-in-the-barrel pattern after hypotension is watershed infarction. Stroke mimic from hypoglycaemia is plausible in a neighbouring presentation, but the chronology, examination or investigation pattern does not match the key discriminator here. Carotid dissection and Thrombectomy-eligible stroke are less appropriate because they would require different localisation, timing or test findings; Intracerebral haemorrhage would fit a different syndrome. Clinical pearl: cervical cord disease would not give cortical border-zone diffusion restriction.

Reference: NICE NG128; National Clinical Guideline for Stroke; DVLA Assessing fitness to drive