über die Thromboendarteriitis obliterans der Hirngefäße (Cerebrale Form der v. Winiwater-Buergerschen Krankheit)

History of the Letzte Wiese/Last Meadow Concept of Brain Ischemia

“…It turned out that with this procedure, a semicircular strip of cerebral cortex covering parts of gyrus sigmoideus posterior, gyrus lateralis, and gyrus postlateralis remained intensely stainednot only in anoxic but also in normoxic control animals-and that the staining was caused by aggregation of dye particles in vessels in which the blood was not properly washed out. The topical pattern of washout failure resembled the previously described histopathological pattern of brain injury after transient experimental occlusion of the pulmonary artery, 5 as well as the pattern of granular atrophy in the cerebral form of von Winiwarter-Buerger's disease, 6 both of which localized to the border zones between the supplying territories of the anterior, middle, and posterior cerebral arteries. The authors, therefore, cautiously raised the question, whether this similarity might be mehr als eine äußere (more than apparent).…”

“…3 A closer look at the original publications reveals that this similarity refers only to 1 subtype of the disease, which is characterized by the generalized-possibly vasospasticinvolvement of the most distant ramifications of all brain arteries including the striolenticular and cerebellar arteries. 6 In this subtype, vascular occlusions colocalize with the semicircular strip of granular atrophy along the cortical border zones, which points to distal local effects rather than to proximal vascular occlusion in combination with a reduction of global blood supply, as postulated by the letzte Wiese concept. However, Miller Fisher later reported a similar morphological pattern after proximal vascular occlusion and concluded that the distal alterations were because of secondary peripheral blood stagnation, followed by thrombotic obliteration of vessels (stagnation thrombosis).…”

The pathogenesis of watershed infarcts in the brain.

“…7 l2 This interpretation was convincingly refuted many years ago by Fisher 5 and later the infarcts have been mostly considered due to a combination of reduced cardiac output and stenosing cerebral athrosclerosis." However, convincing anamnestic or other indications for a reduction in cardiac output have never been given.…”

“…The infarcts frequently give the cortex an appearance of "granular atrophy". 7 Many leptomeningeal arteries over the infarcts are occluded by a material which shows all transitional stages from recent platelet aggregates to completely organized fibrous occlusions. "-l4 These observations thus indicate an ongoing process within the watershed zones.…”

Ocular Manifestations of Insufficiency or Thrombosis of the Internal Carotid Artery*

“…There are a few descriptions in the literature in which the fundus was observed during the attack of transient visual loss. Lindenberg and Spatz (73) reported the case of a patient whose retinal vessels gradually became "snow-white" and then as redness reappeared the vision returned. In one branch of the retinal artery the blood flowed backwards.…”