[Hemorrhage caused by cerebral arterial aneurysm]. / Krovoizliianiia iz arterial'nykh anevrizm golovnogo mozga.

The analysis of clinical pictures and pathomorphology of cerebral damage (intra-operative and autopsy material) was performed on 387 patients with first or second rupture of cerebral arterial aneurysms. Clinicopathological peculiarities of the aneurysmic intracranial hemorrhages were derived. Intracranial pathomorphological determinants of the severity of the patients' conditions at the acute stage were determined, including the intracerebral hematomas resulting in dislocation syndrome and paving the way to penetration of arterial blood spring into the ventricles on the second rupture of the aneurysm. The clinical course of the condition featured a stabilization period whose duration depended on both the type of hemorrhage and cerebral response. This period was regarded as optimal for reconsidering an option of surgical intervention.

[Neurologic manifestations of subarachnoid and parenchymatous hemorrhages caused by arterial aneurysm]. / Nevrologicheskie proiavleniia pri subarakhnoidal'no-parenkhima- toznykh krovoizliianiiakh iz arterial'nykh anevrizm.

Overall 155 patients with subarachnoidal and parenchymatous hemorrhages from arterial aneurysms, mainly of the anterior part of the circle of Willis, were examined. The intensity of subarachnoidal and parenchymatous hemorrhages varied, with the ++diencephalo-hypothalamic area being largely involved. The volume of intraparenchymatous hemorrhages ranged from 10 to 90 ml. Massive basal SAH was accompanied, in a number of cases, by blood congestion in the fourth ventricle. Correlations were established between the gravity of the health status, clinical cerebral decompensation, and the intensity of hemorrhage to the basal subarachnoidal space and cerebral parenchyma. Three variants of clinical decompensation of the brain were revealed: it ran a torpid course in the majority of cases (64%), it increased dramatically in every fourth patient, and gradually regressed in every 10th patient.

[Clinico-anatomic correlations in traumatic ventricular hemorrhage]. / Kliniko-anatomicheskie sopostavleniia pri travmaticheskom krovo- izliianii v zheludochki mozga.

A total of 265 patients with intracerebroventricular hemorrhages were investigated for correlation between clinical manifestations and craniographic, echoencephaloscopic and cerebral angiographic data and brain pathomorphology. Intracerebroventricular hemorrhages were found in cases of severe craniocerebral trauma complicated, as a rule, with skull bones fractures, polar-basal cantusional foci, and intracerebral (rarely meningeal) hematomas. Relationship was established between the severity of craniocerebral lesions and intesites of intracerebroventricular hemorrhages which varied in character depending on the volume of adjacent intracerebral hemorrhage and the area covered by contusional polar-basal foci.

[Difficulties in the timely diagnosis of traumatic intracranial hematomas]. / Trudnosti svoevremennoi diagnostiki travmaticheskikh vnutricherepnykh gematom.

Difficulties and errors of the urgent diagnosis of posttraumatic intracranial hemorrhages are major factors delaying the early detection of an extremely dangerous and potentially fatal complication of brain trauma. These also postpone the recovery after surgical intervention and impair its effect. In emergency ambulance centers 326 cases of intracranial hemorrhages were reviewed and diagnostic errors analysed over 10 years. Diagnostic improvements are described which were efficient in routine examination of head-injure victims in city and district hospitals.

[Surgical tactics in contusions of the cerebral hemispheres]. / Khirurgicheskaia taktika pri ushibakh bol'shikh polusharii mozga.

The author conducted complex examination of 540 patients who were operated on for brain contusion. Comparison of the clinical and instrumental findings with the pathomorphological changes in the brain (disclosed during operation or autopsy) revealed the structural features of contusion foci of convex and pole-basal localization which were factors underlying the three-dimensional enlargement of the affected brain lobe in cases of increasing perifocal edema. The results of surgical management were analysed according to the character of the contusion foci, the extent of traumatic softening of the white matter in the zone of the contusion, and the volume of surgical debridement of the foci. It is concluded that decompression of the brain can be accomplished by removing massive convex and pole-basal contusion foci penetrating the deep layers of the cerebral hemispheres; the volume of surgical debridement of contusion foci is determined by their macrostructure and the size of the zone of white matter softening.

[Tactics of the surgeon in intracranial hematomas associated with contusion foci of the cerebral hemispheres]. / Taktika khirurga pri sochetanii vnutricherepnykh gematom s kontuzionnymi ochagami bol'shikh polusharii golovnogo mozga.

Under analysis was the experience with the treatment of 540 patients with intracranial hematomas as foci of contusion of the brain. A conclusion is made of the necessary surgical treatment of contusion foci of the brain involving deep layers of great hemispheres and followed by extensive white softening of the brain. The method of aspiration with a standard electric operative aspirator should be used for evacuation of the softened brain matter.

[Clinico-anatomic parallels in brain tumors complicated by intracranial hemorrhages]. / Kliniko-anatomicheskie paralleli pri opukholiakh mozga, oslozhnennykh vnutricherepnym krovoizliianiem.

An analysis of 17 cases of intracranial hemorrhage associated with brain tumours is presented. In two-thirds of observations the tumours were malignant, in one-third they were benign and could be referred to glial ones. Two variants of clinical manifestations of tumour hemorrhages into the brain were identified. The clinical time-course of intracerebral hemorrhages was found to correlate with the characteristics of the pathological structure of tumours. The clinical symptomatology was most pronounced when the hemorrhage was into the healthy brain tissue adjacent to the tumour. Hemorrhages into tumours surrounded with a membrane were less severe.

[Volume dynamics of contusion foci of the cerebrum]. / Ob'emnaia dinamika kontuzionnykh ochagov bol'shogo mozga.

Of 740 patients with severe contusions of the brain a group of patients with expansion of the contusion foci was differentiated. In 31.8% of the patients, the contusion foci were localized in the polar-basal portions of the frontal and/or temporal lobes and in 2.5% of patients on the convex surface of the large hemispheres and penetrated into the white matter. Clinical variants of the course of expansion processes of contusion foci are described. The craniographic, echoencephalographic and angiographic characteristics of the damaged brain are also presented. Expansion of contusion foci of the large hemispheres is documented pathomorphologically. A correlation was found between the manifestations of expansion of the contusion foci and their structural characteristics.

[Determination of the degree of severity of cerebral contusions]. / Opredelenie stepeni tiazhesti ushibov golovnogo mozga.

Three degrees of severity of the brain contusion are generally distinguished today for working out the most rational and purposeful treatment. It is quite difficult to judge the severity of the contusion from the neurological picture alone because neurological manifestations of the brain contusions are very diverse and dynamic in character. The authors analysed 630 case records of patients with contusion of the brain and disclosed signs most characteristic of each degree of contusion. In appraising the severity of the contusion, the authors recommend resorting to the laboratory and instrumental diagnostic methods accepted currently in neurosurgical practice in addition to the neurological examination. The complex method of appraising the patients' condition makes the determination of the degree of severity of the brain contusion more trustworthy and objective.