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By S. M. Blinkov

In writing our e-book we had in brain either working towards physicians and scientif­ ic group of workers. we are hoping that the previous will reap the benefits of an research of scientific signs and alterations within the morphological substrate which produce them, and that the latter should be drawn to proof illustrating the resistance of fearful tissue to compression and displacement, and in our notion of the first position performed through blood offer within the sensible disturbances of a deformed mind stem. even though just a short while has elapsed because the first version of the e-book, it's been essential to introduce a few addenda and corrections into the current variation. The bankruptcy "Roentgenological Manifestations of mind Displacements," written by way of N. S. Plevako and Z. N. Polyanker, has additionally been elevated. we're happy efficient publishing residence comparable to Plenum Press has undertaken the yankee ebook 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 e-book Export service provider, within the individual of Galina Aleksandrovna Khudozhnikova, for his or her cooperation.

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Besides the hydrostatic factor, transmission of pressure from a lesion to any part of the brain directly via cerebral tissue is of no lesser importance in the development of dislocations. This thesis is confirmed by the gross brain displacements (revealed by roentgenography) occurring in the absence of symptoms of increased intracranial pressure and with normal cerebrospinal fluid pressure. Such displacements are occasionally observed in extracerebral tumors. The following observation may serve as an example (see Case 5 in Chapter 5): in a slowly developing lipoma of the corpus callosum, clinical signs of increased intracranial pressure were absent.

23. Brain displacement into pontine cisterns. Strangulation groove on the abducens nerve due to pressure from the anterior-inferior cerebellar artery. Cerebellar herniation into the foramen magnum. Arachnoidendothelioma of right frontal lobe. 1, abducens nerve; 2, strangulation groove; 3, anterior-inferior cerebellar artery which has been pulled downward in order to expose the strangulation groove; 4, strongly flattened right trigeminal nerve; 5, vascular grooves. as well. A unique pontine deformation, ansmg upon displacement of cerebrospinal fluid from the pontine cisterns and pressing of the brain stem against the clivus, has been described by Tushevskii (1965).

Bulbar disturbances range from a slight suppression of the swallowing reflex to gross impairment of swallowing, dysphonia, and periods of spontaneous hiccup and vomiting. This is often joined by paroxysmal headache with vomiting, bradycardia, and clouding of consciousness at the peak of seizure. These and other generalized cerebral symptoms of hydrocephalic origin indirectly characterize the degree of a dislocation process in the posterior fossa. The severity of hypertensive paroxysms often is proportional to the size of herniation in the foramen magnum, but frequently they do not correspond to the severity of the symptoms of medullary lesions against whose background they emerge.

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