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By S. M. Blinkov

In writing our booklet we had in brain either training physicians and scientif­ ic team of workers. we are hoping that the previous will reap the benefits of an research of scientific indicators and adjustments within the morphological substrate which produce them, and that the latter might be drawn to proof illustrating the resistance of fearful tissue to compression and displacement, and in our idea of the first function performed via blood offer within the sensible disturbances of a deformed mind stem. even though just a little while has elapsed because the first version of the ebook, it's been essential to introduce a few addenda and corrections into the current variation. The bankruptcy "Roentgenological Manifestations of mind Displacements," written via N. S. Plevako and Z. N. Polyanker, has additionally been improved. we're completely happy powerfuble publishing condo reminiscent of Plenum Press has undertaken the yankee e-book of the booklet; we provide our honest due to Mr. George Onischenko for his first-class translation; and we show our gratitude to Mezhdunarodnaya Kniga, the Soviet booklet Export corporation, within the individual of Galina Aleksandrovna Khudozhnikova, for his or her cooperation.

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An acute herniation is manifested in a sharply increasing headache, chiefly in the occipital region, a gradually increasing rigidity of the neck muscles up to opisthotonos, emergence of a bilateral ptosis, rapid development of somnolence, cyanosis; and hyperthermia. "Black vomiting" may occur, which Vincent et al. regard as an indicator of disturbed mesencephalic function. Respiratory disturbances of Clinical Manifestations of Brain Displacements 47 Cheyne-Stokes' type take place; death may ensue on respiratory paralysis while cardiac activity is still intact.

The cerebral peduncle on the side opposite the tumor is pressed against the free tentorial edge, while the peduncle on the tumor side is protected from the sharp tentorial edge by the hernialike protrusion of the hippocampal gyrus (see Fig. 14). On the opposite side from the tumor, the free tentorial edge produces a groove in the base of the cerebral peduncle. According to Azambuja, Lindgren, and Sjorgen (1956), a more or less deep groove appears on the contralateral peduncle in all cases of brain stem displacement.

A strangulation groove would occasionally be found on the tonsils even in the absence of the clinical symptoms of tonsillar prolapse or herniation. Irger therefore believes that it is not the degrees of brain stem compression that should be differentiated but the degree of severity of functional disturbances in the brain stem, which are due to the action exerted on it by the herniated tonsils. Our interpretation of the lack of correlation between the macroscopically determined signs of brain stem compression and the severity of brain stem dysfunction, which has been pointed out by Irger, is that it is not the compression as such that impairs the brain stem functions but the disturbed blood supply to the brain stem, associated with its compression (for detailed discussion, see Chapter 5).

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