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December 1973, Vol 29, No. 6 >
Article | December 1973

Impaired Perfusion Following Cerebrovascular Stasis: Title and subTitle BreakA Review

Edwin G. Fischer, MD
[+] Author Affiliations

Read before the symposium held at New York Hospital—Cornell Medical Center: The Threshold and Mechanisms of Anoxic-Ischemic Brain Injury, New York, June 10,1973.

Reprint requests to Department of Neurosurgery, Children's Hospital Medical Center, Boston 02115 (Dr. Fischer).


Arch Neurol. 1973;29(6):361-366. doi:10.1001/archneur.1973.00490300023002
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The possibility that a vascular phenomenon might contribute to the brain's inability to survive ischemia for more than several minutes was initially suggested by observations such as those of Ames and Gurian1 and Neely and Youmans.2 The former noted that isolated rabbit retina and optic nerve recovered nearly normal electrical activity following a 20-minute deprivation of oxygen and glucose at 37 C. The latter group demonstrated recovery of dogs from periods of up to 25 minutes of total cerebral ischemia, when produced by intrathecal infusion of saline to a pressure of 400 mm Hg resulting in exsanguination of the brain.

This report summarizes the pertinent work done by the group based mostly at the Massachusetts General Hospital, demonstrating and characterizing an impairment of cerebrovascular perfusion, which begins within the first five to ten minutes of total cerebral circulatory arrest. In addition, it discusses the mechanisms that have thus

REFERENCES

1 +
Ames A III, Gurian BS:  Effects of glucose deprivation of function of isolated mammalian retina . J Neurophysiol 26:617-634, 1963;.
2 +
Neely WA, Youmans JR:  Anoxia of canine brain without damage . JAMA 183:1085-1087, 1963;.
3 +
Ames A III, Wright RL:  Measurement of maximal permissible cerebral ischemia and a study of its pharmacological prolongation . J Neurosurg 21:567-574, 1964;.
4 +
Ames A III, et al:  Cerebral ischemia: II. The no-reflow phenomenon . Am J Pathol 52:437-453, 1968;.
5 +
Kowada M, et al:  Cerebral ischemia: I. An improved experimental method for study: Cardiovascular effects and demonstration of an early vascular lesion in the rabbit . J Neurosurg 28:150-157, 1968;.
6 +
Ginsberg MO, Myers RE:  The topography of impaired microvascular perfusion in the primate brain following total circulatory arrest . Neurology 22:998-1011, 1972;.
7 +
Diethelon AG:  Effect of ischemia upon renal microcirculation: Preliminary observations . Am Surg 35:833, 1969;.
8 +
Kovacs K, Carroll R, Tapp E:  Temporary ischemia of the rat adrenal gland . J Pathol 91:235, 1966;.
9 +
Krug A, deRochemont W, Karb B:  Blood supply of the myocardium after temporary coronary occlusion . Circ Res 19:57, 1966;.
10 +
Sheehan HC, Davis JC:  Renal ischemia with failed reflow . J Pathol 78:105, 1971;.
11 +
Strock PE, Majno G:  Microvascular changes in acutely ischemic rat muscle . Surg Gynecol Obstet 129:1213, 1969;.
12 +
Willms-Kretschmer K, Majno G:  Ischemia of the skin . Am J Pathol 54:327, 1969;.
13 +
Cantu RC, Ames A III:  Distribution of vascular lesions caused by cerebral ischemia . Neurology 19:128-132, 1969;.
14 +
Fischer EG, Ames A III:  Studies on mechanisms of impairment of cerebral circulation following ischemia: Effect of hemodilution and perfusion pressure . Stroke 3:538-542, 1972;.
15 +
Cantu RC, Ames A III:  Experimental prevention of cerebral vascular obstruction produced by ischemia . J Neurosurg 30:50-54, 1969;.
16 +
Cantu RC, et al:  Reversibility of experimental cerebrovascular obstruction induced by complete ischemia . J Neurosurg 31:429-431, 1969;.
17 +
Chiang J, et al:  Cerebral ischemia: III. Vascular changes . Am J Pathol 52:455-476, 1968;.
18 +
Merrill EW:  Rheology of blood . Physiol Rev 49:863-888, 1969;.
19 +
Merrill EW, et al:  Flow of human blood in glass and plastic fibers: A filmed study , in Wolstenholme GEW, Knight J (eds): CIBA Foundation Symposium on Circulatory and Respiratory Mass Transport . London, J & A Churchill, 1969;, pp 130-131.
20 +
Olsson Y, Hossmann KA:  The effect of intravascular saline perfusion on the sequelae of transient cerebral ischemia . Acta Neuropathol 17:68-79, 1971;.
21 +
Kowada M, et al:  Cerebral ischemia: I. An improved experimental method for study; cardiovascular effects and demonstration of an earlier vascular lesion in the rabbit . J Neurosurg 28:150-157, 1968;.
22 +
Cantu RC, et al:  Hypotension: A major factor limiting recovery from cerebral ischemia . J Surg Res 9:525-529, 1969;.
23 +
Miller JR, Myers RE:  Neuropathology of systemic circulatory arrest in adult monkeys . Neurology 22:888-904, 1972;.

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1 +
Ames A III, Gurian BS:  Effects of glucose deprivation of function of isolated mammalian retina . J Neurophysiol 26:617-634, 1963;.
2 +
Neely WA, Youmans JR:  Anoxia of canine brain without damage . JAMA 183:1085-1087, 1963;.
3 +
Ames A III, Wright RL:  Measurement of maximal permissible cerebral ischemia and a study of its pharmacological prolongation . J Neurosurg 21:567-574, 1964;.
4 +
Ames A III, et al:  Cerebral ischemia: II. The no-reflow phenomenon . Am J Pathol 52:437-453, 1968;.
5 +
Kowada M, et al:  Cerebral ischemia: I. An improved experimental method for study: Cardiovascular effects and demonstration of an early vascular lesion in the rabbit . J Neurosurg 28:150-157, 1968;.
6 +
Ginsberg MO, Myers RE:  The topography of impaired microvascular perfusion in the primate brain following total circulatory arrest . Neurology 22:998-1011, 1972;.
7 +
Diethelon AG:  Effect of ischemia upon renal microcirculation: Preliminary observations . Am Surg 35:833, 1969;.
8 +
Kovacs K, Carroll R, Tapp E:  Temporary ischemia of the rat adrenal gland . J Pathol 91:235, 1966;.
9 +
Krug A, deRochemont W, Karb B:  Blood supply of the myocardium after temporary coronary occlusion . Circ Res 19:57, 1966;.
10 +
Sheehan HC, Davis JC:  Renal ischemia with failed reflow . J Pathol 78:105, 1971;.
11 +
Strock PE, Majno G:  Microvascular changes in acutely ischemic rat muscle . Surg Gynecol Obstet 129:1213, 1969;.
12 +
Willms-Kretschmer K, Majno G:  Ischemia of the skin . Am J Pathol 54:327, 1969;.
13 +
Cantu RC, Ames A III:  Distribution of vascular lesions caused by cerebral ischemia . Neurology 19:128-132, 1969;.
14 +
Fischer EG, Ames A III:  Studies on mechanisms of impairment of cerebral circulation following ischemia: Effect of hemodilution and perfusion pressure . Stroke 3:538-542, 1972;.
15 +
Cantu RC, Ames A III:  Experimental prevention of cerebral vascular obstruction produced by ischemia . J Neurosurg 30:50-54, 1969;.
16 +
Cantu RC, et al:  Reversibility of experimental cerebrovascular obstruction induced by complete ischemia . J Neurosurg 31:429-431, 1969;.
17 +
Chiang J, et al:  Cerebral ischemia: III. Vascular changes . Am J Pathol 52:455-476, 1968;.
18 +
Merrill EW:  Rheology of blood . Physiol Rev 49:863-888, 1969;.
19 +
Merrill EW, et al:  Flow of human blood in glass and plastic fibers: A filmed study , in Wolstenholme GEW, Knight J (eds): CIBA Foundation Symposium on Circulatory and Respiratory Mass Transport . London, J & A Churchill, 1969;, pp 130-131.
20 +
Olsson Y, Hossmann KA:  The effect of intravascular saline perfusion on the sequelae of transient cerebral ischemia . Acta Neuropathol 17:68-79, 1971;.
21 +
Kowada M, et al:  Cerebral ischemia: I. An improved experimental method for study; cardiovascular effects and demonstration of an earlier vascular lesion in the rabbit . J Neurosurg 28:150-157, 1968;.
22 +
Cantu RC, et al:  Hypotension: A major factor limiting recovery from cerebral ischemia . J Surg Res 9:525-529, 1969;.
23 +
Miller JR, Myers RE:  Neuropathology of systemic circulatory arrest in adult monkeys . Neurology 22:888-904, 1972;.

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