Plate VII
Click image to enlarge

Plate IV.
Original Observations by Putnam and Adler:
"... lateral ventricles ... lined with gliotic tissue in which lay large veins, many ... surrounded by hematogenous pigment. The sclerotic tissue followed the radial veins for a variable distance, and irregular patches of sclerosis were found at intervals along them ... a large dilated vein leading toward the cortex was surrounded by a sleeve of plaque ... plaques surrounded the larger (venous) trunks at intervals ... - Particularly striking was the irregular, tortuous, congested contour of the main (strongest) (plaque-) veins."

Lesion Specification:
The main lesion, indicated as a "Dawson's finger', forms roughly a cone which rising off of the cerebral ventricular border (V), in a distinct relationship to a strong vein stem. The latter, about one millimeter thick, empties (in the midst of the figure's lower edge) into an epiventricular collecting vein. The former lesion-vein shows, downstream to its thrombotic obstruction (T), striking, peripherally increasing distensions: Its main branch exhibits, downstream to the outermost "Steiner's splash", grotesque distortions. Two other isolated plaques, or "Steiner's splashes", are seen to have emerged immediately distant to the major lesion-vein's thrombus respectively to another lesion-vein's peripheral trifurcation (veins in black, lesions in grey).

Documentary Significance:
This reconstruction model of Putnam and Adler's, of specific cerebral lesions and their veins, offered the first concrete evidence of the lesion-veins' peculiar deformities and of their apparently paradoxical spacial relationships to not so much the ventricle based "Dawson's fingers" as to the cerebrum's isolated plaques, or "Steiner's splashes".

© Dr. F. Alfons Schelling, M.D.