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Member since Jun-04-08 · Last seen May-24-17
Good Day to All! Ma-ayong adlaw sa tanan. And my thanks to for this excellent website. Salamat 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 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 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.

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

   visayanbraindoctor has kibitzed 9113 times to chessgames   [more...]
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   May-02-17 Euwe - Keres (1939/40)
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   Apr-25-17 Alekhine vs Keres, 1942
visayanbraindoctor: <Jack Kerouac: Paul was quite good, but his temperament allowed him to be dominated by the elite masters.> If I may disagree, Paul Keres was never dominated by any leading master, except for Botvinnik (and only in the 1940s upward, as he probably played stronger ...
   Apr-25-17 Kramnik vs Harikrishna, 2017 (replies)
visayanbraindoctor: Probably the most remarkable game I have seen so far in 2017. Congratulations to Kramnik for producing such a brilliant gem. It's not perfect though. Kramnik I believe lost thread of the game early on during the sequence 18. Bg5 Nc5 19. Ba2 h6 20. Bh4 g5 Some comments:
   Apr-25-17 Jose Raul Capablanca
visayanbraindoctor: <RookFile: It sounds egotistical but with Capa it just happens to be the truth.> If one clicks on the tournaments and matches in my post above, Capablanca was achieving Kasparov-like results. True, it was against generally weaker opposition before 1919, but what's ...
   Mar-23-17 Salzburg (1943)
visayanbraindoctor: Fittingly won by World Champion Alekhine and Almost World Champion Keres. This was probably Alekhine's last strong tournament. Keres managed to tie him for first, after failing to do so in three recent occasions. AAA and Keres carried on a strong rivalry between them ...
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Kibitzer's Corner
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Premium Chessgames Member
  visayanbraindoctor: <The bullet entered the back of his skull to the left of the midline and just above the left lateral sinus (a large venous channel that drains blood from the left side of the brain), which it severed. It penetrated the dura mater (the outermost membrane covering the brain), passed through the left posterior lobe of the brain into the left lateral ventricle, and came to rest in the white matter, just above the anterior portion of the left corpus striatum. It fractured both orbital plates of the frontal bone>

So the bullet plowed its way from the occiput to the basal ganglia, and ruptured the lateral sinus. Even today, he could not have been saved.

Premium Chessgames Member
  visayanbraindoctor: <diceman: I've always wondered what exactly "Medical School" was back in the day? Seemed more "we think" vs "we know.">

I have much respect for the doctors of the 19th century. We actually use their drawings in anatomy today. (Anatomy never changes.) I think the main difference is that they did not have a good idea of antiseptic technique or microbes; and intubating patients and placing them on ventilators was not yet invented.

Going farther back, I have seen a drawing by da Vinci of the skull base. It is remarkably accurate, showing the holes in the base of the skull and the major cranial nerves. It could pass for a text book drawing in modern medical books.

At that time, I believe most doctors were schooled in the time honored manner of master-apprentice training. You did not have to pass through medical school. And they were good doctors given the technology at that time. These physicians gave us modern medicine.

I am really such a weirdo for a doctor. I actually do not believe that the medical board exam is necessary. Students who want to be good doctors will by themselves study and train to become good doctors, as they have been doing so for more than two thousand years.

Premium Chessgames Member
  visayanbraindoctor: 7 April 2017.

4M, fell down and hit his head on the floor of a basketball court after getting bumped by another child. He had a 60cc epidural hematoma.

(Right parietal craniectomy, evacuation of epidural hematoma. 4/7/17 9:20 to 9:46 am. No BT.)

As in other such pre-pubertal cases, I expect the bone to grow back and cover the skull defect. Children (and even young teenagers) are able to regrow their skull bones as long as the dura is intact.

The child woke up post-op and should survive.

Premium Chessgames Member
  visayanbraindoctor: <savagerules, diceman>

If you notice, the patient I operated on

<(Partial right frontal lobectomy, evacuation of intracerebral hemorrhage, repair of dura for CSF leak with temporalis muscle flap, bone transplant to left hemi-abdomen SQ layer. 3/6/17 10:44 am to 12:41 pm. 1 unit BT.)>

resembles Lincoln's case, but the bullet traveled in reverse, from the frontal lobe to the occiput.

So why did my patient survive? It's because

1. The bullet's path was more superiorly located, and thus did not hit the basal ganglia and deeper structures.

2. The bullet did not lacerate a lateral sinus, which really bleeds a lot. (All the blood in the brain drains into the two lateral sinuses.)

President Lincoln apparently also went to cardiopulmonary arrest. Even if he got revived, the resulting hypoxia would have caused massive brain swelling in an already injured brain, and that would have resulted in brain herniation and death.

Premium Chessgames Member
  visayanbraindoctor: <diceman> Doctors have atrocious handwriting. Full of erasures too. Seems traditional. I could barely decipher what they were writing in President Lincoln's case.
Apr-08-17  savagerules: Thx for the info about Lincoln. It seems surprising after reading the extent of the damage done to him from the .44 caliber bullet from Booth's gun that he lived for another 9 hours after being shot. Booth only had one shot to kill Lincoln since he was using a Derringer and it had to be reloaded after each shot.
Premium Chessgames Member
  visayanbraindoctor: 9 April 2017.

They come in pairs; another child with an EDH, in exactly the same part of the head.

3M, got hit by an ambulance.

(Right parietal craniectomy, evacuation of epidural hematoma. 4/9/17 6:48 to 7:11 pm. No BT.)

Awake post-op.

Premium Chessgames Member
  visayanbraindoctor: 10 April 2016.

38M, shot by unknown assailant.

The bullet entered the left occipital area, caused the underlying bone to collapse into the left cerebellum, bounced, and then exited out of the right occipital area. The left cerebellum incurred a hemorrhagic contusion, which was pressing on the brainstem. Although the patient was awake, he exhibited impaired gag reflex.

I also decided to do a tracheostomy.

OR 1: (Bi-suboccipital craniectomy, evacuation of left cerebellar hemorrhagic contusion and bone fragments. 4/10/17 6:45 to 7:49 pm. No BT.)

OR 2: (Tracheostomy 4/10/17 8:10 to 8:28 pm)

Premium Chessgames Member
  visayanbraindoctor: <savagerules> I read the autopsy report more closely. It did not actually say that the bullet hit the basal ganglia. Instead the bullet <came to rest in the white matter, just above the anterior portion of the left corpus striatum>.

It's actually possible that President Lincoln's case may resemble my patient's after all, if the deeper structures were not directly hit.

If Lincoln did not actually go into CP arrest and herniate (as indicated by dilated pupils), he may have had a chance to survive, hooked to a ventilator in a modern ICU facility.

If his pupils had dilated after the resuscitation attempt, he would have eventually died anyway, even in a modern ICU.

Premium Chessgames Member
  visayanbraindoctor: 13 April 2017.

53M, three weeks PTA a coconut fell on the patient's head. Since then he has developed progressive numbness and weakness on the left. Typical acute subdural hematoma that turned into a chronic one.

(Right fronto- parietal craniectomy, evacuation of chronic subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 4/13/17 3:12 to 4:03 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 14 April 2017.

28F, on a SUV that crashed on the highway (driver error). At the ER, she was still GCS 6, pupils 2mm equally briskly reactive to light. She had a huge epidural hematoma of more than 80 cc. She had also aspirated and was in severe respiratory distress. She also had a left femur fracture.

Given the size of the EDH, even without blood I ordered for a stat craniectomy. When she arrived in the OR, she was already GCS 3, both pupils 7 mm nonreactive to light. She had herniated.

Since the patient was already in the OR and the herniation had just occurred I decided to proceed with the operation.

When I opened up, the EDH was not clotted (that is a blackish solid clot). Instead, fresh blood spurted out of the epidural space beneath the bone. She was still actively bleeding from a coronal diastatic fracture. There was a small dural tear, and so I decided to open up the dura in order to explore the subdural space. There was fresh blood both in the subdural and the subarachnoid space. Her brain was not pulsating (a sign of a dead brain).

She went on CP arrest while I was closing; and could not be revived. A table death.

(Left fronto- parietal craniectomy, evacuation of epidural hematoma. 4/14/17 3:20 to 4:00 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: 20 April 2017.

2F; the child accidentally fell down and hit her had on a rock.

(Right parieto- temporal craniectomy, evacuation of epidural hematoma. 4/20/17 9:54 to 10:22 am. No BT.)

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  visayanbraindoctor: 26 April 2017.

41M, pedestrian, hit by a motorcycle. He was stuporous at GCS 9, with a 40cc left temporal epidural hematoma. Temporal bleeds are particularly dangerous as they tend to cause the adjacent uncus of the temporal lobe to herniate.

(Left temporao- parietal craniectomy, evacuation of epidural hematoma, bone transplant to left hemi-abdomen SQ layer. 4/26/17 8:46 to 9:55 pm. No BT.)

He also had a left tibia-fibula fracture, but this isn't an emergency. If he survives the critical period of 3 days, I'll transfer him to an Orthopedic surgeon.

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  visayanbraindoctor: 29 April 2017.

40M, 6 days PTA- motorcycle fall, driver, hit another motorcycle.

It's another late referral. He was referred to me only when he deteriorated yesterday. I had to transfer him from a public hospital that has no craniectomy set to another on with a set.

Pre-op he was GCS 7 with anisocoric pupils.

(Right fronto- parietal craniectomy, evacuation of acute subdural hematoma, bone transplant to left hemi-abdomen SQ layer. 4/29/17 12:33 to 1:10 am. No BT.)

I operated at midnight since I thought he would not last the night. I operated clean and fast.

In the morning he became brain dead anyway. On top his brain problems, he also had aspirated and had pneumonia and sepsis.

An early messy and bloody operation always beats a late clean and fast one, ceteris paribus.

Premium Chessgames Member
  visayanbraindoctor: 29 April 2017.

5F, the child fell off a balcony.

She was awake pre-op but had CSF leak on an open depressed fracture.

(Right parieto- temporal craniectomy, repair of dura for CSF leak with periosteum. 4/29/17 8:21 to 8:55 pm. BT post-op.)

The bone will just grow back since the patient is a child.

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  visayanbraindoctor: 11 May 2017.

68M, sudden loss of consciousness.CT scan showed a 50 cc right thalamic hemorrhage. Pupils 1.5 mm ESRTL.

I usually do not operate on these cases as the prognosis is very poor, but in this case, the patient was still localizing to pain (GCS 7). The family was also aggressive.

(Right fronto- parietal craniectomy, cortisectomy evacuation of thalamic hemorrhage, bone transplant to left hemi-abdomen SQ layer. 5/11/17 1:23 to 3 pm. No BT.)

(Tracheostomy. 3/23/17 3:25 to 3:42 pm.)

Thalamic hemorrhages are located deeply. I approached it the safest way- a frontal approach anterior to the pre-central gyrus (which is the motor cortex), I had to dig through 10 cm of cortex and white matter in order to reach it. I then proceeded to evacuate nearly all of it.

I did not have any problems during the operation. There was little bleeding. (The secret here is to cauterize all blood vessels first on the cortisectomy site, do not pull on them but instead transect them with scissors, and suction out the surrounding brain parenchyma carefully.) I hope he survives, but give his age, I am not that confident.

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  visayanbraindoctor: 13 May 2017.

49F, sudden loss of consciousness.CT scan showed a 50 cc right frontal intracerebral hemorrhage and right hemisphere acute subdural hematoma. Pupils 1.5 mm ESRTL.

She had already aspirated, and was running a high fever due to pneumonia. Bad prognosis, but with the family cooperative, I decided to proceed.

(Right frontal craniectomy, evacuation of acute subdural hematoma, cortisectomy, evacuation of frontal lobe hemorrhage, bone transplant to left hemi-abdomen SQ layer. 5/13/17 3:24 to 4:30 pm. No BT.)

(Tracheostomy. 3/23/17 4:38 to 4:53 pm.)

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  visayanbraindoctor: 14 May 2017.

52M, motorcycle fall, driver, alone. The patient not only had the usual frontal hemorrhagic contusion; he also had a right frontal lobe infarct following the anterior cerebral artery (ACA) territory. (This shows up in the CT scan as a vaguely triangular hypodense area with clear-cut borders.) He came in GCS 13, but was deteriorating.

(Right fronto- parietal craniectomy, partial right frontal lobectomy, bone transplant to left hemi-abdomen SQ layer. 5/14/17 5:05 to 6:30 am. No BT.)

I decided to remove the infarcted and severely contused portions of his right frontal lobe. There was minimal intracerebral hemorrhage.

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  visayanbraindoctor: 16 May 2017.

37M, motorcycle fall, driver, alone. GCS 10 (stuporous). CT scan showed a large bifrontal- right temporo- parietal hemorrhagic contusion.

The patient's sensorium was deteriorating, so I operated even near midnight.

(Right fronto- parietal- temporal craniectomy, evacuation of cerebral hemorrhage, bone transplant to left hemi-abdomen SQ layer. 5/16/17 11:01 to 11:56 pm. No BT.)

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  visayanbraindoctor: 18 May 2017.

18M, whom I operated on for left occipital epidural hematoma last 9/6/16. Case of motorcycle fall, driver, alone.

(Replacement of bone flap left occipito- parietal. 5/18/17 6:45 to 7:20 pm. No BT.)

Premium Chessgames Member
  visayanbraindoctor: Mortalities:

Entry 1.

<13 May 2017.

49F, sudden loss of consciousness.CT scan showed a 50 cc right frontal intracerebral hemorrhage and right hemisphere acute subdural hematoma. Pupils 1.5 mm ESRTL.

She had already aspirated, and was running a high fever due to pneumonia. Bad prognosis, but with the family cooperative, I decided to proceed.

(Right frontal craniectomy, evacuation of acute subdural hematoma, cortisectomy, evacuation of frontal lobe hemorrhage, bone transplant to left hemi-abdomen SQ layer. 5/13/17 3:24 to 4:30 pm. No BT.)

(Tracheostomy. 3/23/17 4:38 to 4:53 pm.)>

Next day on D1, the patient was awake and followed orders. On D2, she was GCS 3. I suspect she had another stroke. She died.

Entry 2:

<11 May 2017.

68M, sudden loss of consciousness.CT scan showed a 50 cc right thalamic hemorrhage. Pupils 1.5 mm ESRTL.

I usually do not operate on these cases as the prognosis is very poor, but in this case, the patient was still localizing to pain (GCS 7). The family was also aggressive.

(Right fronto- parietal craniectomy, cortisectomy evacuation of thalamic hemorrhage, bone transplant to left hemi-abdomen SQ layer. 5/11/17 1:23 to 3 pm. No BT.)

(Tracheostomy. 3/23/17 3:25 to 3:42 pm.)

Thalamic hemorrhages are located deeply. I approached it the safest way- a frontal approach anterior to the pre-central gyrus (which is the motor cortex), I had to dig through 10 cm of cortex and white matter in order to reach it. I then proceeded to evacuate nearly all of it.

I did not have any problems during the operation. There was little bleeding. (The secret here is to cauterize all blood vessels first on the cortisectomy site, do not pull on them but instead transect them with scissors, and suction out the surrounding brain parenchyma carefully.) I hope he survives, but give his age, I am not that confident.>

Day 1 post-op, patient was awake and followed orders. On D2, he was comatose at GCS 7. CT scan showed hydrocephalus. Some of the thalamic hemorrhage had spilled into the ventricles.

In many of these cases, the HCP resolves. In this case though, the prolonged bedridden hospital stay and the patient's advanced age is a sure ticket into the pneumonia-sepsis roller coaster ride. 68M began to run a high fever and died of sepsis.

Premium Chessgames Member
  visayanbraindoctor: 20 May 2017.

23M, motorcycle fall, driver, hit by a truck. GCS 9 (stuporous). CT scan showed a bifrontal hemorrhagic contusion.

(Bi frontal craniectomy, evacuation of subdural hygromas, bone transplant to left hemi-abdomen SQ layer. 5/20/17 5:59 to 7:25 pm. BT 1 unit FWB.)

The sagittal sinus bled during the operation. I had to tack and fold dura over it in order to stop the bleeding.

Premium Chessgames Member
  Jonathan Sarfati: Sorry about the mortalities on 18 May, especially after both regained consciousnes.

I looked up HCP and could find only hereditary coproporphyria, which doesn't make sense, so I suppose hydrocephalus.

49 is young for a hemorrhage almost as large as Capablanca's. If she had another stroke, presumably bad hyperension?

Sepsis and pneumonia in hospitals is a concern. I thought they were quite antiseptic places.

Premium Chessgames Member
  visayanbraindoctor: <Jonathan Sarfati: I looked up HCP and could find only hereditary coproporphyria, which doesn't make sense, so I suppose hydrocephalus.>

Yes. It's common in thalamic hypertensive hemorrhages. The thalamus is located right next to the third ventricle, so large hemorrhages in the thalamus often rupture into the ventricular system, which then blocks proper CSF flow, causing communicating hydrocephalus. In this case, the pre-op CT scan did did not show HCP yet; it developed post-op.

<49 is young for a hemorrhage almost as large as Capablanca's. If she had another stroke, presumably bad hyperension?>

Yes. However, as with most indigent patients, they hardly consult doctors; and so the relatives don't really know.

<Sepsis and pneumonia in hospitals is a concern. I thought they were quite antiseptic places.>

Unfortunately bedridden comatose patients, especially the elderly, often get pneumonia. It's the rule, not the exception. If you can't cough up your secretions, it stays in your lungs, bronchi, and trachea, and becomes a smorgasbord for bacteria.

Premium Chessgames Member
  Jonathan Sarfati: Would such a patient routinely be measured for HTN? Capablanca was measured at 280/140 when admitted after his thalamic hemorrhage.
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