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Abstract Watershed (WS) infarction is a type of ischemic stroke which can be defined as infarction in a region of the brain where the distributions of nutrient arteries meet, or overlap; in these areas, tissue perfusion is most compromised when blood flow is decreased (Stedman’s Medical Dictionary, 2006), watershed infarction has two types; cortical watershed (CWS) and internal watershed (IWS) (Bogousslavsky, 1986). The most important and specific risk factor for WSI is hemodynamic impairment. Several factors lead to decrease perfusion pressure such as (severe hypotension due to blood loss, shock, heart failure…); local causes (extra cranial or intracranial stenosis) play the major role in the pathogenesis of WSI. Intracranial stenosis is a narrowing of the arteries inside the brain similar to carotid stenosis in the neck (Ringer et al., 2005). Aim of the work 1. To identify the prevalence of watershed infarction among all types of acute ischemic stroke. 2. To assess the relationship between watershed infarction and intracranial stenosis.Subjects and Methods One hundred and seventeen Egyptian patients were recruited into this hospital-based case-control study. Clinical history, laboratory indices, structural brain imaging, Magnetic Resonance Angiography (MRA) and Carotid Duplex ultrasonography were done for all patients. Results Watershed infarction was present in 19% of study population. Intracranial stenosis were identified as a significant risk factors for both types of watershed infarction (cortical and deep) (p=0,003, p=0,037 respectively). Extra cranial stenosis were identified as a significant risk factors for deep watershed infarction (p=0,020). Intracranial stenosis was present 43.6% of patients, 27.3% were symptomatic and 16.3% were a symptomatic. Hypertension were identified as a significant risk factors for intracranial stenosis (p=0.045). |