Watershed Infarct due to Massive Pulmonary Embolism: A Rare Diagnosis at the Emergency Department

Abstract

Introduction: Watershed infarcts, which involve the hemodynamic risk zones that are the junction of distal fields of nonanastomosing arterial systems, can occur due to hemodynamic mechanisms such as hypotension and hypovolemia.Case Report: We present the case of an 86-year-old woman who complained of syncope, was confused, had a seizure at the emergency service and was diagnosed with watershed infarct of the right hemisphere, which was secondary to massive pulmonary embolism.Conclusion: Watershed infarcts can occur due to embolic or hemodynamic mechanisms. Massive pulmonary emboli can cause watershed infarcts via hemodynamic mechanism by causing resistant hypotension. Watershed infarcts coexist with pulmonary embolism; therefore, embolic patients may present with neurological symptoms. Therefore, watershed infarcts must be considered for patients with high risk factors for embolism

Keywords

• Pulmonary embolism, watershed infarction, stroke

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