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visayanbraindoctor
Member since Jun-04-08 · Last seen Aug-13-17
Good Day to All! Ma-ayong adlaw sa tanan. And my thanks to CG.com for this excellent website. Salamat CG.com. Opinions:

1. World Chess Championship

The true Chess World Champions are the holders of the Traditional Title that originated with Steinitz & passed on in faithful succession to Lasker, Capablanca, Alekhine, Euwe, Botvinnik, Smyslov, Tal, Petrosian, Spassky, Fischer, Karpov, Kasparov, Kramnik, Anand, and Carlsen. The sacredness of this Title is what makes it so valuable.

And how does one become the true Chess World Champion? In general, by beating the previous Titleholder one on one in a Match! Matches are preferred over Tournaments because of the Tradition of the WC Succession & because the chance for pre-arranging a Tournament result is more likely. The only exceptions to this rule:

A. In case where the Candidates and World Champion participate in an event that all the participants agree to be a World Championship event because of extraordinary circumstances.

Thus, the 1948 World Championship Tournament was justifiable because of the death of the Title holder Alekhine.

Likewise, the 2007 WC Tournament was justifiable under the extraordinary circumstances of the Chessworld trying to heal its internal rift over the 1993 Kasparov Schism. Anand himself became the World Champion in this 2007 Tournament & not in 2000 when he won a knock-out FIDE Tournament. Caveat: Some chess fans deem the 2007 WC Tournament as illegitimate, considering that Anand became the World Champion only in 2008, when he beat the previous Titleholder Kramnik in a WC match. From this perspective Anand only became the Undisputed World Champion in 2008.

Karpov lost his Title to Kasparov in 1985, & never regained it in the 1990s events that FIDE labeled as 'world championships'. All solely FIDE Champions that emerged outside WC Traditional Succession elaborated on above, strong as they were, were not true World Champions (eg., Bogolyubov 1928, Khalifman 1999, Ponomariov 2002, Kasimdzhanov 2004, Topalov 2005).//

B. In case the previous Titleholder refuses to attend (or defaults) an event that the Chessworld largely deems as a World Championship event in the Tradition of the World Championship Succession. Thus, Karpov was the true successor to Fischer who resigned (or defaulted) their WC Match in 1975.

2. The strongest chess events in different eras of chess history?

Because of the brain's limitations explained below, the best professional (amateurs don't matter much in top level chess) chess players of each generation beginning in the Lasker era have always played at a similar level - near the maximum allowed by human standards. Now there are larger cohorts of chess professionals post WW2 than preWW2 thanks to government state funding in the Soviet era and presently corporate funding. The result is that large preWW2 tournaments had numerous 'bunnies', relatively weak players. By the Kasparov era, super-tournaments that featured most of the top ten, and no bunnies, had became more common. However, the top 4 or 5 since Lasker's time have always been very strong.

Consequently the smaller the top-player-only tournament, the stronger it gets. For any era. If there was a double round robin tournament in 1914 featuring Lasker, Capablanca, Alekhine, and Rubinstein, and no other, it would be as strong as any present day super-tournament.

Now weed out everyone except the two strongest players in the world. What we (usually) get is the chess World Championship match.

There has been talk of elite tournaments, composed only of the strongest top masters and no weaker bunnies replacing the World Championship match in prestige, probably because of the assumption that they would be the strongest chess events possible. False assumption. The strongest chess events in chess history generally have been World Championship matches. Even the strongest masters in each generation usually do not match the world champion and challenger in chess strength. In a World Championship match, the contestant has to meet the monster champion or challenger over and over again, with no weaker master in between. Capablanca vs Lasker 1921 was just as strong a chess event as the recent Carlsen vs Anand 2013, and far stronger than Zurich 2014. (Imagine having to play 14 straight games with a computer-like errorless Capablanca at his peak.)

3. The strongest chess players in chess history?

First, it's possible to compare chess players from different eras by 'using' players with long careers whose active playing spanned across at least three or four decades. Some historical examples involving World Champions and Almost World Champions are Lasker, Alekhine, Keres, Botvinnik, and Korchnoi. Specifically, Lasker as an old man man in the 1920s was beating the hypermoderns. An 'old' Alekhine meted out crushing defeats to young Flohr and Keres in the 1930s and 40s, and was clearly better than them. Keres whose peak was probably in 1938 to 1943 played terrific chess until the 1970s, and nearly got to be Challenger again in the 1950s and 60s, beating a whole slew of younger players. This included Korchnoi who until the 2000s could give good account of himself playing the teen Grandmasters of the turn of the century.

Second and more important, I believe that we can rationally compare chess players from different eras by using objective computer analysis of their middlegames and endgames (not openings). We can 'ask' the computers how accurately the players are playing. They take the place of the stopwatch. As far as I know, nearly every computer study using various programs has always placed Capablanca at number one or two in terms of accuracy. Computers 'love' Capablanca's play.

Thus the 1919 version of Capablanca & the 1971 version of Fischer, both of whom played practically error-free chess, are it; updated in opening theory, they should beat anyone in a match.

If computers were self-aware, I have no doubt that they would unanimously choose the 1916 to 1924 Capablanca as the strongest chess player in history. And please no red herring remark that Capa played only 'simple' chess. This young Capablanca played some of the most complicated, sharp, double edged, and bizarre positions possible; and played them without making a single losing error (and by all accounts with unsurpassed quickness), something that has always befuddled my mind when I got to peruse through his games.

We have to take this question in the context of the limits of the human Anatomy and Physiology. A concrete example would be the one hundred meter dash. The human body is designed such that the limit it can run is about 9 seconds. In order for a human being to run faster, we would have to redesign the human anatomy into that of say a cheetah. One can rev up the human Anatomy and Physiology, say with steroids, but this regimen would hit an eventual Stonewall too; the same way that we could rev up human proficiency to learn openings with computer assistance.

Since the Nervous System has physiological limits (example of a limit- neuronal action potential speed don't go up much more than 100 m/s) and so limits the human chess playing ability, increasing the number human chess players, thus expanding the normal curve of players, simply creates more possibilities of players playing like a Fischer in his prime, but will not create a mental superman who plays chess at computer levels. This explains why human and computer analysis indicate that Lasker was playing on a qualitatively similar level as more recent WCs.

'Worse' in chess, any computer assistance ends once the opening is over. After a computer-assisted opening prep, every GM today has to play the game the way Lasker did a hundred years ago, relying on himself alone, with the same fundamental chess rules and chess clock. An Encyclopedic opening repertoire is not a necessity to be a top player. In fact, there are World Champions who did not do deep opening prep; they just played quiet but sound openings that got them into playable middlegames and then beat their opponents in the midlegame or endgame. Just look at Capablanca, Spassky, Karpov, and now Carlsen.

Because of subconscious adherence to the narcissistic generation syndrome, the belief that everything that is the best can only exist in the here and now, many kibitzers would not agree to the above theses. While it is true that there have been more active chess professionals and consequently larger cohorts of top chess masters on a yearly basis since WW2 thanks to Soviet state funding and present corporate funding, the very top chess masters since Lasker's time have always played at a similar level- within the limits imposed by the human brain. There is no physical law that bars a pre-WW2 chess master from playing chess as well as today's generation. The human brain has not changed in any fundamental manner in the past tens of thousands of years.

4. The greatest chess players in history?

A related question is who is the greatest chess player in history. The answer depends on the criteria one uses. Since I place great emphasis on the ability to play world class chess for the longest period of time, Lasker would be it. He was playing at peak form from 1890 age 22 (when he began a remarkable run of match victories over Bird, Mieses, Blackburne, Showalter, and culminating in his two massacres of Steinitz) until 1925 at age 57 (when he nearly won Moscow after winning new York 1924). Kasparov (high plateau from 1980 to 2005) and Karpov (high plateau from 1972 to 1996) would follow. (At their very peak though, I believe that Kasparov was stronger than Karpov, and both were stronger than Lasker; and the peak Capablanca and Fischer were stronger than any of them.)

5. Computers vs Humans, who is stronger?

Another related question is how history's top masters would fare against computers. It's obvious from Kasparov's time that computers would totally crush them all. Opening knowledge would not matter much. Computers swamp human opponents in the middle game, simply by calculating more variations more rapidly by several orders of magnitude.

6. On the game and chess players young and old, past and present:

The proposition that an older player would not be able to adjust to the openings and methods of a younger generation is false, as evidenced by the observation of strong masters whose careers happened to span generations beating the tar out of weaker masters of the next generations. (See #3 above.)

This 'inter generational knowledge/theory leveling phenomenon' holds true today and will probably still hold true two decades from now. As of 2017, Kramnik, Anand and Topalov, and a few years ago Gelfand are living smoking gun proofs that the speculation that the older generation cannot adopt to newer openings is false. Older players have always adapted and will always adapt to the latest openings in the vogue. The present day young players will do the same 20 years from now, faced with a future generation of rising chess players.

The notion that computers are more advantageous to younger players IMO is not quite right. Younger players should have more energy and stamina in studying chess openings and endgames for long hours everyday compared to older players without computers, but the use of computers would tend to make the learning process easier for every one including the older ones.

As a corollary, computers also make it easier today for very young players in their early teens to peak at a younger age than in past eras, although they tend to level off in their early 20s to their high plateau, defined by their inborn talents and determination.

In brief. computers tend to level chess learning for everyone, young and old.

This is not a rigid rule. The best games I have ever seen played by a 12-13 year old are Capablanca's; and Tal, Karpov, and Kasparov reached their high plateau in their early 20s in a computer-less era, similar to computer age Carlsen. However let it be noted that Carlsen reached his peak sidestepping intensive computer-prepped tactical openings and beating his competitors in the old fashioned way in the middlegame and endgame. These masters peaked early not because of computers by because of their immense chess talent. Perhaps normal rules do not apply to these geniuses.

Another false notion is that the nature of the middlegame today is somehow different from the middlegame in the past. The easiest way to prove the wrongness of this proposition is by observing CG's daily puzzles. Do not peek at the names of the players that played these puzzles, and don't look at the dates. Can you glean from the middlegame play and combinations in the puzzles the date they were played? You can't. You would not know if it was played in 2016, 2000, 1950, or 1900. Chess combinations don't just suddenly change their stripes just because a hundred years have passed.

Another observation is that when the best masters of the past, Lasker, Capablanca, and Alekhine met the occasional 'modern' structures of the Sicilian Scheveningen and Dragon, KID, Modern Benoni, Benko Gambit, they played strategically perfectly, in just the way these opening structures should be played. So how did these masters play openings and the resulting middlegame structures that are deemed incomprehensible to them by some of today's dogmatically 'modern' kibitzers? The answer is that chess rules and principles have not changed. Center, rapid development, open files and diagonals, holes, weak pawns, piece activity, initiative and attack, positional sacrifices and all types of combinations were as familiar to them as to us.

Note that it is the frequencies of a few middlegame pawn structures that have changed since WW2. Not the Ruy Lopez or QGD, but obviously Sicilians and KIDs are much more common post-WW2. Since so many games nowadays begin with the Sicilian and KID, people associate these with being 'modern' (which is a rather vague undefined term IMO). But certainly Lasker and Capablanca understood the middlegame principles behind them and when they did get these positions they played them excellently, like the top masters they are.

Moreover, Keres is another smoking gun, bomb proof evidence of the fallacy of Watson's speculation that 'the best players of old were weaker and more dogmatic than the best players today', and Larsen's assertion that he would crush everyone in the 1920s. The glaring fact is that Keres is a pre-WW2 master who began his career in the late 1920s, and played competitively up to the 1970s, and he did learn (and contributed) to the newer opening variations (the most famous of which is the Keres attack which he invented in 1943). The ideal way for Watson and Larsen to prove their statements is to beat a top pre WW2 master such as Keres. They failed. Tellingly enough an aging Keres beat both a rising Watson and a peak Larsen when they happened play each other.

7. Regarding the topic on Physical compared to Mind prowess.

IMO improvement in 'physical' prowess, is mainly based on muscles and sports equipment and apparel.

So the same methods can't be done for the 'mind'.

Most people miss this out, but there is a big difference between improving muscles and the brain.

Muscles can hypertrophy. One can input in better ways to hypertrophy them, such as specialized gym equipment and exercises, and steroids.

On the other hand neurons do not hypertrophy.

Furthermore the 'hardwiring' of our nervous system mostly occurs when we were kids. Although we keep on learning throughout our lives, the last major upgrade was when the myelinization of our nerve fibers was completed when we were about 4 years old.

The above is the reason why I believe that if we are to produce an upgrade of the Capablanca type of chess genius (extremely rapid and accurate way of playing), we would have to start with kids 4 years old and below.

8. On ratings:

Elo ratings reflect relative and not absolute chess strength.

Chessplayers are naturally arranged in populations partitioned by geopolitical regions & time periods that have infrequent contacts with one another. Within such a population, players get to play each other more frequently, thus forming a quasi-equilibrium group wherein individual ratings would tend to equilibrate quickly; but not with outside groups. With caveats & in the proper context, FIDE/Elo ratings are simply fallible descriptors & predictors of an active player's near-past & near-future performances against other rated players, & only within the same quasi-equilibrium group.

As corollaries: the best way to evaluate a player's strength is to analyze his games & not his ratings; one cannot use ratings to accurately compare the quality of play of players from the past and present, or even the same player say a decade ago and today; & care should be taken in the use of ratings as a criterion in choosing which players to seed into the upper levels of the WC cycle. All the above often entail comparisons between players from different quasi-equilibrium groups separated by space and/or time.

Regarding inflation deniers, they imply that Elo ratings reflect absolute and not relative chess strength. Professor Elo himself would condemn their view. If the top 20 players were to suffer a serious brain injury and begin playing like patzers, but play no one else for the next decade, they would more or less retain their 2700s ratings, although they would be playing terrible patzerish chess.

9. Best Qualifiers?

The credible, fair, tried & tested Zonals - Interzonals - Candidates (with known strong players directly seeded into the Interzonals & Candidates; & here ratings may be used with caveats) over the random World Cup and the elitist Grand Prix. If possible long Candidate matches and 16 to 24 game World Championship matches. However, with the passing of the state-funded chess era of Soviet times, I begin to doubt if the strict money guzzling qualification process above can be re-installed.

10. The 1993 Chess Rift and Kramnik:

Regarding the Rift in the chessworld after Kasparov split in 1993, I believe that Kramnik has done more than any other individual in helping heal it by concrete actions - agreeing to a WC Match with Topalov in 2006 & not walking out when he could have done so with the support of most of the world's top GMs after getting accused of cheating; & agreeing to Defend his Title in a WC Tournament in 2007, the first time a living Titleholder has agreed to do so in chess history. My eternal gratitude to him.

11. Finances of a would-be Challenger:

Regarding all kinds of problems chessplayers outside of Europe & the USA face in their quest for the Title, Capablanca & Anand have proven it's possible for a non-European non-USA chessplayer to be World Champion; but apparently only if you have the chess talent of a Capablanca or Anand! For others, I guess they would have to try to get monetary support & good seconds somewhere to have some hope for a Title shot.

12. Ducking a World Championship re-match:

Alekhine vs. Capablanca - Not definitively resolved. If pushed, I would tend to favor Capablanca given that pre-WW 2, there was no definitive cycle to choose the Challenger &, after all is said and done, it was the Champion who set the conditions & who chose his Challenger. AAA could & should have chosen Capa; & there was ample time, more than a decade, to do so before WW2. On the other hand, Capa's pride may have caused him to behave arrogantly & thus offend AAA. The issue is very much debatable. //

Kramnik vs. Kasparov - For me, it's resolved. Kudos to Kramnik for trying his best to install a decent Qualifying Event. Kasparov for his reasons clearly did not want to go through the Qualifying Event that he himself had pledged before losing his Title; & did not even seem serious in playing the solely FIDE champions. Why? I can only speculate that Kasparov would rather retire than risk a loss in a Qualifier or a match to either a FIDE champion or to Kramnik. If he regained his Title, he would be the greatest Champion in history, but there was risk involved. If he retired, he would still be the greatest Champion in history, but there would be no risk involved. Kasparov chose the latter & no one should blame him for that decision; & more so don't blame Kramnik!

13. Predictions for Hypothetical World Championship Matches:

Lasker vs. Pillsbury, Rubinstein, Maroczy - Lasker wins 2, loses 1 match //

Lasker vs. Capablanca (inexperienced) 1914 - Lasker close win //

Capablanca (not overconfident & not having TIAs) 1929 to 1937 vs. Alekhine or any other master - Capa win //

Alekhine (sober & prepared) vs. Capablanca (w/ severe HPN & numerous past strokes), Botvinnik, Keres, Fine, Reshevsky, Flohr 1939 - Alekhine win //

Alekhine (alcoholic, ill, & depressed) vs. Botvinnik 1946 - Botvinnik win //

Fischer (inactive for 3 years) vs. Karpov 1975 - Karpov win//

Kasparov vs. Shirov 2000 - Kasparov win. (But GKK should still have given it to Shirov. And don't blame Kramnik. Had Kramnik declined, GKK would have chosen another; & Shirov would still be frustrated.)

14. My thoughts regarding the quick game tiebreakers for the World Championship Match:

i. Ideally the Champion must have beaten the old one to be Champion.

ii. I hate these FIDE quick game tie-breaks to decide the Classical Champion.

iii. The tiebreakers should be as fair as possible.

Notice that in the traditional Champion-retains-Title-in-a-tie, all the Champion needs is a tied match to retain his Title. Advantage Champion.

My recommendation is we give more Whites to the Challenger. Advantage Challenger.

So things even out.

We still retain the tradition of the Challenger beating the Champ to get the Title.

The Challenger gets to do it in a classical game, not a quick game.

Thus suggestion if the World Championship match ends in a tie:

Additional classical games with a limit, wherein the Challenger receives more Whites. If the Champion manages to tie or win at the end, he retains the Title.

Thus the tiebreaker can be one extra White game for the Challenger. Or two, three, or four. We could even vary further, say one Black followed by one to three Whites for the Challenger. Studies can be made in order to determine the best specific format (of Blacks and Whites) that can afford the Challenger a fair chance at winning.

IMO this would probably be welcomed by most of the chess world in terms of the sporting excitement it affords. Here we have the Challenger; forced to try all means to win in classical games against a sitting Champion that only needs to draw all the tiebreak games (or game). A real drama at the end of the match. If the match still ends in a tie, the Champion retains his Title, and deservedly so since he got more Blacks.

This way the Challenger must beat the Champion in a classical game (not a quick game) in order to grab the Title, and in so doing win the match outright.

---

I have opened a <'multi-experimental' forum> below. Its nature is that of several secret social and psychological experiments, whose objectives and parameters, and the rules that follow, are strictly defined and which I may or may not reveal. Readers of this forum might be able to deduce some of these rules. Accordingly messages shall be retained or removed with or without explanation, even those from my dear friends here in CG, although I am making it clear here that absolutely no offense is intended to any one in this experiment. I may or may not respond to certain questions and messages, also according to the rules. To my friends: Please bear with me in this matter.

---

Ongoing project to preserve and teach non-Tagalog minority Philippine languages (in danger of disappearing).

https://www.youtube.com/channel/UCC...

>> Click here to see visayanbraindoctor's game collections.

Chessgames.com Full Member

   visayanbraindoctor has kibitzed 9230 times to chessgames   [more...]
   Aug-13-17 twinlark chessforum
 
visayanbraindoctor: <India And Pakistan Blame Each Other For Tensions In Kashmir Region> https://southfront.org/india-and-pa... It sounds pretty depressing, but in spite of the severe geopolitical tension in Syria and North Korea, it is still my belief that the first post WW2 nuclear ...
 
   Aug-11-17 Jose Raul Capablanca (replies)
 
visayanbraindoctor: <maxi: Perhaps <visayanbraindoctor> or somebody else can explain how is it possible for somebody to have such high blood pressures. devere: Even today it is sometimes a mystery.> They call theses cases 'essential' hypertension because no one really knows for ...
 
   Aug-08-17 Carlsen vs Nakamura, 2017 (replies)
 
visayanbraindoctor: <cro777: <Nf8: According to the Norwegian super computer http://analysis.sesse.net/ Carlsen missed two wins - 41.Kg5 and 43.h5.>> The principle involved: Create a passed pawn as far away from your other locked-in pawns. Somehow I think great rook ending ...
 
   Aug-07-17 visayanbraindoctor chessforum
 
visayanbraindoctor: <Jonathan Sarfati: How would treatment of a brain abscess differ from that of a cyst?> In brain abscesses, you give third generation cephalosphorins (Ceftazidime or Ceftriaxone). On the other hand cysts are sterile. You don't have to give third generation ...
 
   Aug-06-17 Carlsen vs M Vachier-Lagrave, 2017 (replies)
 
visayanbraindoctor: <ChessHigherCat: the interference move f4!> Carlsen might have missed this too. It seems that the only time that Carlsen ever loses (with rare exceptions) is when he misses a tactical shot or goes awry in sharp tactical positions. He is almost unbeatable in ...
 
   Aug-06-17 Annie K. chessforum
 
visayanbraindoctor: I had to delete the original video above because I found significant errors on review. Here's the new corrected one. https://www.youtube.com/watch?v=QGe...
 
   Aug-06-17 Carlsen vs Karjakin, 2017 (replies)
 
visayanbraindoctor: <Calli: Karjakin is just too passive. The whole Nd2-Nb3-Na5 manuevre is an example.> allows <RookFile: These slow buildups can be really hard to play against.> Carlsen just loves this kind of game. He plays them flawlessly. The waste of tempi by Karjakin ...
 
   Aug-06-17 W So vs Carlsen, 2017 (replies)
 
visayanbraindoctor: What was So thinking? Was it Carlsen vs Aronian, 2015 or Aronian vs Carlsen, 2017 when he played 19. Bf4? In both cases, Carlsen, a known pawn grabber, snatches the pawn. Then loses. So offers a pawn. Carlsen happily grabs, it. Then wins. History did not repeat itself ...
 
   Jul-02-17 Altibox Norway (2017) (replies)
 
visayanbraindoctor: <frogbert: here's my point of view: there really is no objective way to tell whether the fact that there were only 2-3 guys at any point in time that were close to Kasparov at the same time, while there are 10 guys that are close to Carlsen now (at the same time) means
 
   Jun-14-17 Aronian vs Carlsen, 2017 (replies)
 
visayanbraindoctor: Aronian does an Aronian's immortal. Organizers should bring back the old brilliancy prizes (with corresponding cash awards). This is the most brilliant attack I have seen for this year. Aronian plays not only against Carlsen's psyche (the Wold Champion is a known pawn ...
 
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Jun-11-17
Premium Chessgames Member
  visayanbraindoctor: 11 June 2017.

52F, sudden decrease in sensorium. CT scan showed a midbrain right thalamic hemorrhage, a hypertensive bleed. There also was associated obstructive hydrocephalus, because the bleed was pushing against the aqueduct of Sylvius and third ventricle.

I decided to do a decompression craniectomy and to attempt a tube ventriculostomy.

(Right frontal craniectomy, bone transplant to left hemi-abdomen SQ layer. 6/11/17 2:25 to 3:23 pm. No BT.)

Unfortunately, I could not hit the frontal horn of the right ventricle. I deduced that it has probably collapsed because of the pressure exerted by the hemorrhage. Instead, I got some old dark blood clots on the tip of the tube I inserted. (I use Foley catheters because there are no available silastic tubings in my setting.)

I surmised that I had probably hit the blood clot itself. Since the brain collapsed to below the inner table (which meant that I had decompressed the brain), I decided to abort the procedure.

I do not like this development. Doing tube ventriculostomies on these hemorrhages can be dangerous because the blood clot skews the normal anatomy, and i am doing the procedure blind. (I aim through the intersection of the planes demarcated by the nose or medial canthus and the ear, and insert the tube 6 cm deep.) I could have done more harm than good by damaging some important brain structure, or even by dislodging a clot which was exerting tamponade on a vessel that's about to bleed again.

Jun-12-17
Premium Chessgames Member
  visayanbraindoctor: 12 June 2017.

16M, motorcycle fall, driver, by himself, drunk while driving. Comatose and anisocoric upon arrival in a private hospital, so I intubated him. The family had no money for a private admission, so I transferred him to the public city hospital. Then the family was delayed in buying necessary OR needs. It was only after more than 24 hours that I finally got to operate on him.

(Left frontal craniectomy, evacuation of epidural hematoma, bone transplant to left hemi-abdomen SQ layer. 6/12/17 9:59 to 10:49 pm.)

Jun-16-17
Premium Chessgames Member
  Jonathan Sarfati: <visayanbraindoctor>, how would you treat someone with a minor stroke but a crisis-level BP, say 190/130? Is there a drug of choice to bring this down safely and quickly?
Jun-16-17
Premium Chessgames Member
  visayanbraindoctor: <Jonathan Sarfati: <visayanbraindoctor>, how would you treat someone with a minor stroke but a crisis-level BP, say 190/130? Is there a drug of choice to bring this down safely and quickly?>

In my setting internists (and me as well) usually give IV Nicardipine drip.

Sometimes in my setting, this isn't available. If there is any Hydralazine (Apresoline) amp, I give it IV.

In case you're away from the hospital with no way to insert an IV line, you could give Nifedipine sublingual.

Jun-16-17
Premium Chessgames Member
  visayanbraindoctor: 6 June 2017.

54F, whom I operated on for right falcine meningioma last 6/7/16.

(Replacement of bone flap bi-frontal. 6/6/17 9:20 to 10:30 am. No BT.)

Jul-01-17
Premium Chessgames Member
  visayanbraindoctor: 17 June 2017.

Rare case of a young 33M with hypertensive basal ganglia hemorrhage. He used to have a drug habit. GCS 7 pre-op.

(Left fronto- parieto- temporal craniectomy, cortisectomy superior temporal gyrus, evacuation of intracerebral hemorrhage, bone transplant to left hemi-abdomen SQ layer. 6/17/17 2:28 to 5:10 pm.)

Jul-01-17
Premium Chessgames Member
  visayanbraindoctor: 26 June 2017.

21M, fell down mango tree while working for the owner.

The CT scan showed a right cerebellar epidural hematoma, subarachnoid hemorrhage, and also hydrocephalus. He exhibited nuchal catch (stiff neck upon lifting the head), and was complaining of severe headache. So I thought he could be in the beginning stages of cerebellar tonsillar herniation.

After some thought, I decided not to do a tube ventriculostomy, because I figured that the HCP would just resolve. I decided instead to decompress by doing a small frontal craniectomy. Let's see what happens.

(Right frontal craniectomy, bone transplant to left hemi-abdomen SQ layer. 6/22/17 10:01 to 10:39 am.)

(Right suboccipital craniectomy, evacuation of epidural hematoma. 6/22/17 11:15 am to 12:19 pm.)

Jul-01-17
Premium Chessgames Member
  visayanbraindoctor: 27 June 2017.

17M, motorcycle fall, backrider, hit by another motorcycle.

I also decided to do a tracheostomy because he had aspirated.

(Left temporo- parieto- frontal craniectomy, evacuation of left hemisphere acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 6/27/17 9:18 to 10:10 pm.)

(Tracheostomy. 6/27/17 10:20 to 10:29 pm.)

Jul-01-17
Premium Chessgames Member
  visayanbraindoctor: 30 June 2017.

33M, motorcycle fall, driver, fell by himself, drunk.

(Left fronto- parieto- temporal craniectomy, evacuation of left hemisphere acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 6/30/17 10:10 to 10:49 am.)

Jul-01-17
Premium Chessgames Member
  visayanbraindoctor: 30 June 2017.

59M, motorcycle fall, driver, fell by himself, drunk.

His brain was anatomically normal in the CT scan, but he had aspirated, and was in severe respiratory distress. I did not do any craniectomy.

(Tracheostomy. 6/30/17 11:36 to 11:52 am.)

Jul-01-17
Premium Chessgames Member
  visayanbraindoctor: 1 July 2017.

<26 June 2017.

21M, fell down mango tree while working for the owner.

The CT scan showed a right cerebellar epidural hematoma, subarachnoid hemorrhage, and also hydrocephalus. He exhibited nuchal catch (stiff neck upon lifting the head), and was complaining of severe headache. So I thought he could be in the beginning stages of cerebellar tonsillar herniation.

After some thought, I decided not to do a tube ventriculostomy, because I figured that the HCP would just resolve. I decided instead to decompress by doing a small frontal craniectomy. Let's see what happens.

(Right frontal craniectomy, bone transplant to left hemi-abdomen SQ layer. 6/22/17 10:01 to 10:39 am.)

(Right suboccipital craniectomy, evacuation of epidural hematoma. 6/22/17 11:15 am to 12:19 pm.)>

21M's hydrocephalus not only did not resolve, he also began exhibiting signs of meningitis (fever, nuchal catch, incoherence). I decided to do a tube venticulostomy in order to evacuate CSF.

I just reopened my previous right frontal craniectomy site, and did not do any new incision.

(Tube venticulostomy. 7/1/17 4:40 to 5:04 pm.)

If the CSF results shows WBC or bacteria, it would probably mean that the patient has developed ventriculitis, which carries a poor prognosis. It's very hard to treat and keeps on recurring. My old master says it's because the bacteria hides in the ependyma (the lining of the ventricles) where it's isolated from systemic antibiotics.

Jul-14-17
Premium Chessgames Member
  visayanbraindoctor: 4 July 2017

<30 June 2017.

59M, motorcycle fall, driver, fell by himself, drunk.

His brain was anatomically normal in the CT scan, but he had aspirated, and was in severe respiratory distress. I did not do any craniectomy.

(Tracheostomy. 6/30/17 11:36 to 11:52 am.)>

Died of pneumonia and sepsis after a severe episode of cerebral hypoxia due to the NODs failing to clean the tracheostomy tube's inner cannula. It turned out the nurses were new and had no idea of the necessity of cleaning the trach, or how to do it. (This commonly occurs in public hospitals.)

Jul-14-17
Premium Chessgames Member
  visayanbraindoctor: 6 July 2017.

55F, fell down stairs.

The consent was delayed by 6 hours as the sister-in-law, who was the only one to accompany the patient, had to wait for the arrival of other relatives. The patient meanwhile deteriorated from GCS 7 anisocoric to GCS 5 both pupils dilated. I rushed the operation once consent was given.

(Left temporo- parieto- frontal craniectomy, evacuation of left hemisphere acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 7/6/17 4:40 to 5:40 pm.)

Post-op the patient was brain dead.

Jul-14-17
Premium Chessgames Member
  visayanbraindoctor: 7 July 2017.

21M, motorcycle fall, driver, hit by another motorcycle.

The accident happened almost two weeks ago. The Neurologist tried to manage the patient without referring to a Neurosurgeon. The patient deteriorated and became comatose. So the Neurologist intubated the patient and referred to me.

(Right fronto- parieto- temporal craniectomy, evacuation of right hemisphere acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 7/7/17 10:35 to 11:28 pm.)

Fortunately the patient woke up post-op.

Jul-14-17
Premium Chessgames Member
  visayanbraindoctor: 12 July 2017

<<26 June 2017.

21M, fell down mango tree while working for the owner.

The CT scan showed a right cerebellar epidural hematoma, subarachnoid hemorrhage, and also hydrocephalus. He exhibited nuchal catch (stiff neck upon lifting the head), and was complaining of severe headache. So I thought he could be in the beginning stages of cerebellar tonsillar herniation.

After some thought, I decided not to do a tube ventriculostomy, because I figured that the HCP would just resolve. I decided instead to decompress by doing a small frontal craniectomy. Let's see what happens.

(Right frontal craniectomy, bone transplant to left hemi-abdomen SQ layer. 6/22/17 10:01 to 10:39 am.)

(Right suboccipital craniectomy, evacuation of epidural hematoma. 6/22/17 11:15 am to 12:19 pm.)>

21M's hydrocephalus not only did not resolve, he also began exhibiting signs of meningitis (fever, nuchal catch, incoherence). I decided to do a tube venticulostomy in order to evacuate CSF.

I just reopened my previous right frontal craniectomy site, and did not do any new incision.

(Tube venticulostomy. 7/1/17 4:40 to 5:04 pm.)

If the CSF results shows WBC or bacteria, it would probably mean that the patient has developed ventriculitis, which carries a poor prognosis. It's very hard to treat and keeps on recurring. My old master says it's because the bacteria hides in the ependyma (the lining of the ventricles) where it's isolated from systemic antibiotics.>

The patient turned out to have cavitary TB. He was deteriorating due to pneumonia and hydrocephalus. Since the employer bought the appropriate OR needs, I decided to be aggressive.

(Ventriculo-peritoneal shunting right parietal. 7/12/17 10:41 to 11:39 am.)

I had to make 10 incisions between the scalp and the right upper quadrant in order to pass the peritoneal catheter, because the public hospital did not have a shunt passer.

(Tracheostomy. 7/12/17 11:46 to 11:57 am.)

The patient died anyway from sepsis near midnight at the same day.

Jul-14-17
Premium Chessgames Member
  visayanbraindoctor: 14 July 2017.

35M, motorcycle fall, driver, hit a tricycle.

The CT scan showed a comminuted depressed fracture (underneath an open scalp laceration). I decided to clean the area. I removed bone fragments and a small stone the went inside the wound.

(Left parieto- frontal craniectomy. 7/14/17 10:08 to 11:00 am.)

Jul-23-17
Premium Chessgames Member
  visayanbraindoctor: 16 July 2017.

30M, motorcycle fall, driver, by himself, stuporous.

He is a soldier; police and soldiers seem to have an unusually high rate of motorcycle accidents.

(Right parieto- temporal craniectomy, evacuation of epidural hematoma, bone transplant to left hemi-abdomen SQ layer. 7/7/17 10:35 to 11:28 pm.)

Patient woke up post-op.

Jul-23-17
Premium Chessgames Member
  visayanbraindoctor: 23 July 2017.

66M, progressive right hemiparesis and sensorial changes in the past two weeks.

The CT scan indicated a cyst (seen as a round hypodensity) in the left frontal lobe, just anterior and inferior to the motor cortex. The brain surrounding the cyst was markedly edematous.

I expected a difficult operation because the bipolar cautery in the public City Hospital isn't working. I would have to do a cortisectomy and try to excise the cystic tumor with a monopolar cautery, which can get bloody.

Somewhat to my surprise, it turned out to be a brain abscess. I have operated only on a few of these, and they do mimic cystic tumors in CT scans. If these occur in the frontal lobe, they're usually from an infection in the facial sinuses.

(Left fronto- parietal craniectomy, excision of brain abscess, bone transplant to left hemi-abdomen SQ layer. 7/23/17 12:40 to 2:24 pm.)

Jul-27-17
Premium Chessgames Member
  visayanbraindoctor: 27 July 2017.

39M, hacked by known assailant, two times on the left face and head. CN VII was severed and he can't move his left facial muscles. His motor cortex is also affected, so he has contralateral right sided hemiparesis.

(Left temporo- parietal craniectomy, repair of dura. 7/27/17 10:20 to 11:31 am. No BT.)

Aug-06-17
Premium Chessgames Member
  visayanbraindoctor: 1 August 2017.

Entry 1.

7M, fell down stream and hit head on a rock.

(Mid parietal-occipital craniectomy, evacuation of EDH. 8/1/17 11:01 to 11:38 am. No BT.)

Entry 2.

6F, on motorcycle that crashed, driven by father.

(Right frontal craniectomy, repair of dura for CSF leak and brain fungus. 8/1/17 12:50 to 2:42 pm. No BT.)

Aug-06-17
Premium Chessgames Member
  visayanbraindoctor: 4 August 2017.

64M, motorcycle fall, driver, by himself.

(Bi-frontal craniectomy, evacuation of right hemisphere acute subdural hematoma, evacuation of left hemisphere subdural hygroma, bone transplant to left hemi-abdomen SQ layer. 8/4/17 10:01 to 11:30 am.)

The patient remained stuporous post-op. I think I will have to do a repeat CT scan.

Aug-06-17
Premium Chessgames Member
  visayanbraindoctor: 5 August 2017.

Entry 1.

26M, hacked.

(Left temporo- parietal craniectomy, repair of dura. 8/5/17 11:42 am to 12:27 pm. No BT.)

Entry 2.

52F, whom I previously operated on 17 December 2016 for acute subdural hematoma.

(OR: Replacement of bone flap left temporo- fronto- parietal. 8/5/17; 3:40 to 4:20 pm. No BT.)

Next day I was puzzled why the patient was still drowsy. They're supposed to wake up after a mere return-of-bone operation. I did a repeat CT scan. It showed that her old infarct (dead temporal lobe area secondary to traumatic contusion) had undergone hemorrhagic conversion.

My Neurologist and I transferred her to the stroke unit. Fortunately, she remained quite arousable and communicative (with her old dysphasia). I do not plan a re-operation as of now.

Aug-06-17
Premium Chessgames Member
  visayanbraindoctor: 6 August 2017.

39M, motorcycle fall, driver, hit by a Pajero.

(Left frontal craniectomy, repair of dura for CSF leak and brain fungus with temporalis muscle flap. 8/6/17 2:58 pm to 4:26 pm. No BT.)

The patient's brain was spilling all over his face pre-op due to a large skull defect on his forehead. So all the nurses were looking on with interest. I had to flap over the left temporalis muscle in order to plug in the hole in his frontal and ethmoid bones.

Aug-06-17
Premium Chessgames Member
  Jonathan Sarfati: How would treatment of a brain abscess differ from that of a cyst? Would topical antibiotics be needed to kill any remaining bacteria?
Aug-07-17
Premium Chessgames Member
  visayanbraindoctor: <Jonathan Sarfati: How would treatment of a brain abscess differ from that of a cyst?>

In brain abscesses, you give third generation cephalosphorins (Ceftazidime or Ceftriaxone). On the other hand cysts are sterile. You don't have to give third generation cephalosphorins.

It turned out I was wrong. I had samples of the cyst wall biopsied. The pathologist reported it as 'metastatic carcinoma'. Gram Stain and Culture Sensitivity also turned out negative. My first impression was correct. So the whitish viscous liquid I recovered was NOT pus. It was NOT a brain abscess. It was a cystic brain tumor after all.

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