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American Journal of Medical Case Reports. 2024, 12(4), 58-63
DOI: 10.12691/AJMCR-12-4-1
Case Report

Border-zone Infarct of the Corpus Callosum: A Case Report, Vascular Anatomy & Review of Literature

Nithisha Thatikonda1, , Vijaya Valaparla1, Aabishkar Bhattarai1, Chilvana Patel1 and Anand Vilaschandra Patel2

1Department of Neurology, University of Texas Medical Branch Galveston, Texas

2Department of Neurology, Baylor College of Medicine, Houston, Texas

Pub. Date: April 06, 2024

Cite this paper

Nithisha Thatikonda, Vijaya Valaparla, Aabishkar Bhattarai, Chilvana Patel and Anand Vilaschandra Patel. Border-zone Infarct of the Corpus Callosum: A Case Report, Vascular Anatomy & Review of Literature. American Journal of Medical Case Reports. 2024; 12(4):58-63. doi: 10.12691/AJMCR-12-4-1

Abstract

Corpus callosum infractions (CCI) are rare, accounting for only 3% of all ischemic strokes. CC derives its rich blood supply from anterior and posterior circulations with extensive anastomosis near the splenium tip, providing inherent protective redundancy to reduced blood flow. The presence of intracranial atherosclerotic disease (ICAD) impairs this cerebrovascular reserve, increasing susceptibility to ischemia and subsequent infarction. The border zone is more hemodynamically unstable when both circulations are affected simultaneously or in the presence of congenital anatomical variations in the cerebral vasculature. In such circumstances, accentuated hypoperfusion of the cerebral border zones secondary to systemic hypotension results in the development of border-zone infarct of the CC. We present a 47-year-old male with a midline border-zone infarct of CC due to diffuse ICAD with superimposed systemic hypoperfusion in the peri-procedural period of coronary artery bypass grafting (CABG). Due to the peculiar vascular involvement by ICAD, the infarction was isolated to CC, sparing the more common cortical border zones. Following the case report is a review discussing various anatomical locations, classifications, and pathophysiology of border-zone infarcts, with a specific focus on the vascular anatomy of the corpus callosum.

Keywords

corpus callosum, border zone infarct, systemic hypoperfusion, intracranial atherosclerotic disease

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]  Sparr S.A., Bieri P.L. Infarction of the Splenium of the Corpus Callosum in the Age of COVID-19: A Snapshot in Time. Stroke. 2020; 51(9): 223-26.
 
[2]  Singhal P., Bahri N. A case of acute corpus callosum infarction - CT and MRI findings. Eurorad Case images. 2020; 16657.
 
[3]  Farooq H., Ziad A., Khan Q et al. Corpus Callosum Infarct in the Background of Varicella-Zoster Infection: A Report of a Rare Case. Cureus. 2022; 14(10): e29943.
 
[4]  Chaudhari D., Renjen PN., Arora AS. Acute corpus callosum infarct. Neurol India. 2019; 67(3): 930-931.
 
[5]  Zhang Z., Meng X., Liu W., et al. Clinical Features, Etiology, and 6-Month Prognosis of Isolated Corpus Callosum Infarction. Biomed Res Int. 2019(14): 9458039.
 
[6]  Li S., Sun X., Bai YM., et al. Infarction of the corpus callosum: a retrospective clinical investigation. PLoS One. 2015; 18; 10(3): e0120409.
 
[7]  Ambady P. Midline Watershed: Unusual Border-Zone Infarct of the Corpus Callosum. Journal of Clinical Case Reports. 2014; 4(10).
 
[8]  Türe U., Yaşargil M.G., Krisht A.F. The arteries of the corpus callosum: a microsurgical anatomic study. Neurosurgery. 1996 Dec;39(6):1075-84; discussion 1084-5.
 
[9]  Gottesman R.F., Sherman P.M., Grega M.A., et al. Watershed strokes after cardiac surgery: diagnosis, etiology, and outcome. Stroke. 2006; 37(9): 2306-11.
 
[10]  Kasow D.L., Destian S., Braun C., et al. Corpus callosum infarcts with atypical clinical and radiologic presentations. Am J Neuroradiol. 2000; 21(10): 1876-80.
 
[11]  Riedy G., Melhem E.R. Acute infarct of the corpus callosum: appearance on diffusion-weighted MR imaging and MR spectroscopy. J MagnReson Imaging. 2003; 18(2): 255-9.
 
[12]  Murthy S.B., Chmayssani M., Shah S., et al. Clinical and radiologic spectrum of corpus callosum infarctions: clues to the etiology. J ClinNeurosci. 2013; 20(1): 175-7.
 
[13]  Momjian-Mayor I., Baron J.C. The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies. Stroke. 2005; 36(3): 567-77.
 
[14]  Bhalla K., Garg D., Rajan M., et al. Unilateral Transient Watershed Cerebral Infarct in a 6-Year-Old Girl with Frequently Relapsing Nephrotic Syndrome. J Nat Sci Biol Med. 2018; 9(1): 90-92.
 
[15]  Rotman J., Zimmerman R. Patterns of Ischemic Stroke: From Lacunar to Territorial to Multiple Embolic to Watershed Hypotensive. Neurovascular Imaging. 2014.
 
[16]  Stamm B., Lineback M.C., Tang M., et al. Diffuion-Restricted Lesions of the Splenium Clinical Presenation, Radiographic Patterns, and Patient Outcomes. Neurology Clin Pract. 2023.13(5)e200196.
 
[17]  Mangla R., Kolar B., Almast J., et al. Border zone infarcts: pathophysiologic and imaging characteristics. Radiographics. 2011; 31(5): 1201-14.
 
[18]  Derdeyn C.P., Videen T.O., Yundt K.D., et al. Variability of cerebral blood volume and oxygen extraction: stages of cerebral haemodynamic impairment revisited. Brain. 2002; 125(Pt 3): 595-607.
 
[19]  Derdeyn C.P., Grubb R.L Jr., Powers W.J. Cerebral hemodynamic impairment: methods of measurement and association with stroke risk. Neurology. 1999; 53(2) 251-9.
 
[20]  Torvik A. The pathogenesis of watershed infarcts in the brain. Stroke. 1984; 15(2): 221-3.
 
[21]  ElSadek A., Gaber A., Afifi H., et al. Microemboli versus hypoperfusion as an etiology of acute ischemic stroke in Egyptian patients with watershed zone infarction. Egypt J NeurolPsychiatrNeurosurg. 2019; 55(1): 2.
 
[22]  Muppala H., Kumar A. Watershed cerebral infarction - A case report. IAIM, 2020; 7(11): 44-55. < https:// www.researchgate.net/ publication/ 355094724_Watershed_cerebral_infarction_-A_case_ report>.
 
[23]  Derdeyn C.P., Khosla A., Videen T.O., et al. Severe hemodynamic impairment and border zone—region infarction.Radiology.2001; 220(1): 195-201.
 
[24]  Kimura K., Minemastu K., Koga M. Microembolic signals and diffusion-weighted MR imaging abnormalities in acute ischemic stroke. AJNR. 2001; 22(6): 1037–42.
 
[25]  Martin A.R. Contribution of microembolic signal detection in cardio embolic stroke. Science Direct. 2012; 1: 214–7.
 
[26]  Ramez R., David I., Simon J., et al. Watershed infarcts in transient ischemic attack/minor stroke with ≥ 50% carotid stenosis. Stroke. 2010; 41: 1410–6.
 
[27]  Caplan L.R., Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 1998; 55(11): 1475–1482.
 
[28]  Moriwaki H., Matsumoto M., Hashikawa K., et al. Hemodynamic aspect of cerebral watershed infarction: assessment of perfusion reserve using iodine123-iodoamphetamine SPECT. J Nucl Med 1997; 38(10): 1556–1562.
 
[29]  Zheng M.S., Aping S. Clinical and Imaging Analysis of a Cerebellar Watershed Infarction. Chinese Medicine. 2015; 6: 54-60.
 
[30]  Amarenco P., Kase C.S., Rosengart., et al. Very small (border zone) cerebellar infarcts. Distribution, causes, mechanisms and clinical features. Brain. 1993; 116 ( Pt 1): 161-86.
 
[31]  Wright J.N., Shaw D.W.W., Ishak G., et al. Cerebellar Watershed Injury in Children. AJNR Am J Neuroradiol. 2020; 41(5): 923-928.
 
[32]  John S., Hegazy M., Cheng Ching E., et al. Isolated bilateral middle cerebellar peduncle infarcts. J Stroke Cerebrovasc Dis. 2013; 22(8): e645-6.
 
[33]  Savoiardo M., Bracchi M., Passerini A., et al. The vascular territories in the cerebellum and brainstem: CT and MR study. AJNR Am J Neuroradiol.1987; 8(2): 199-209.
 
[34]  Cormier P.J., Long E.R., Russell E.J. MR imaging of posterior fossa infarctions: vascular territories and clinical correlates. Radiographics.