Bulbar watershed ischemic stroke: the comma-shaped sign-a case series

Neuroradiology. 2021 Nov;63(11):1947-1950. doi: 10.1007/s00234-021-02754-3. Epub 2021 Jun 30.


Watershed infarcts can involve the brainstem, with lesions distributed across the terminal supply from the vertebral and cerebellar arteries. Brain imaging can highlight a comma-shaped lesion at the edge of vertebral and posteroinferior cerebellar artery vascularization territory. Such peculiar MRI lesion shape might suggest a watershed hypoperfusion etiology and direct workup towards causes of hemodynamic impairment, including postural hypotension, cardiac failure, or vertebral artery origin occlusion.

Keywords: Brainstem; Bulbar cardiovascular lesions; Posteroinferior cerebellar artery; Vertebral artery.

MeSH terms

  • Brain Ischemia* / diagnostic imaging
  • Cerebral Arteries
  • Humans
  • Ischemic Stroke*
  • Stroke* / diagnostic imaging
  • Vertebral Artery