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

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.