[Purtscher disease. Range of variation of clinical manifestations in 11 patients and pathogenetic considerations]

Eleven patients with M. Purtscher are presented with different manifestations of the retinopathy. The main characteristics are (1) yellowish-white "Purtscher-Flecken", which have a polygonal margin and are lying in the inner nuclear layer between the arterioles, (2) white typical cotton-wool-spots located in the nerve-fiber-layer covering the vessels and hemorrhages, which are (3) spot-like or (4) flame-shaped due to their location in the different retinal layers. All of these four manifestations may be isolated or combined, as we have observed in bilateral cases. Ten cases were caused by trauma of the thorax or the skull and one by pancreatitis. The pathogenesis of M. Purtscher can be explained by microembolization. An intravasal coagulation and/or aggregation of leukocytes resp. thrombocytes may develop after trauma as well as in pancreatitis. This may lead to microinfarcts and hemorrhages. The "microinfarct-hypothesis" has been experimentally proved and is able to explain the rarity of M. Purtscher, the range of variation, the monolateral and bilateral manifestation and identical ophthalmoscopic pictures despite different etiology.