< Earlier Kibitzing · PAGE 6 OF 6 ·
|Jul-08-14|| ||scormus: Player of Gor!|
|Dec-25-14|| ||wordfunph: <Jonathan Sarfati> Merry Christmas!|
|Jul-15-15|| ||chessmaster102: hello Johnathan, i am doing some research on Ortvin sarapu and you seem to have known him much more personally than anyone else on this site judging from your comments on his page. Did you too ever study together or do post-mortem ? what was his upbringing as a chess player if you know by any chance ? (coached by anyone , favorite books etc..)|
|Aug-31-15|| ||Jonathan Sarfati: <G'day, chessmaster102:>
Yes, we did plenty of post-mortems together after games, and we corresponded for a time. His autobiography Mr Chess explains more of his pre-NZ career which was considerable for a young man. Unfortunately, he was 40 years older than I.|
|Dec-01-15|| ||visayanbraindoctor: <Jonathan Sarfati> Wow! Thank you for the autopsy report.|
Capa had what is commonly called a hypertensive thalamic hemorrhage. Most of the big ones I have seen (such as described) are invariably fatal.
Small background: The ascending reticular activating system are neuronal cell bodies that run from the upper pons to mesencephalon to the diencephalon on either side of the ventricular system (4th ventricle, aqueduct of sylvius, and third ventricle). Severe damage to an ipsilateral aspect of it results in permanent coma. Apparently Capa had a big one (5cm by 5cm in the thalamus is big) on the right thalamus. <Right thalamus almost totally destroyed, with some pieces in the anterior horn of the right lateral ventricle. Where the thalamus was, there was a hematoma 5 cm wide and 5 cm high.> The last statement implies that the volume was approximately 60cc.
The big thalamic hemorrhages typically rupture into the medial adjacent third ventricle, which is why <The whole ventricular system was flooded with blood>
The internal capsule where the motor controlling cortico spinal tract runs is adjacent to the thalamus and further down crosses to the opposite side in the cervico medullary junction, and so the contralateral side is paralyzed. Thus <paralyzed his left face, left side>
I don't understand this though: <with the left pupil dilated and unresponsive to light.> It should be the ipsilateral pupil that should dilate first, which is the right pupil in this case. Probably a typo in the autopsy report? The dilated pupil indicates that the uncus, the medial part of the temporal lobe, had herniated into the tentorial fossa because of pressure from the blood clot.
In any case, once a patient comes in comatose with a dilated pupil in a case of hypertensive thalamic hemorrhage with rupture into the ventricles, he is doomed. I have never seen one survive. I have operated on perhaps a dozen of these, the last one a few months ago, and I try to remove the hemorrhage (usually via a large frontal cortisectomy which is the least bloody approach), and also the drain the bloody CSF from the ventricular system via a tube ventriculostomy, but every one of the cases with the large hemorrhages have died or gone into a persistent vegetative state. (The results are so discouraging that nowadays, I just do it if the family insists, and it's really just to console them with the thought that everything including an operation was done.)
The smaller ones that rupture into the ventricular system usually result in hydrocephalus, and I usually do emergency drainage via a tube ventriculostomy. Most of them survive, but usually with hemiparesis of the contralateral side. However, in Capa's case, it was a huge bleed.
Such a hemorrhagic stroke usually occurs after years and years of hypertension. Small micro aneurysms develop in thalamostriate arteries, and if the hypertension remains uncontrolled, they typically eventually rupture, and you get a thalamic hemorrhage. This comprises around 15% of hypertensive hemorrhage cases, but the larger ones carry a very poor prognosis.
I hope Capa became unconscious quickly. Patients with brain hemorrhages suffer from the biggest intolerable headache of their lives, and the survivors who happen to have no amnesia tell me that they felt that their heads were exploding.
Unfortunately, during that era, there was no effective anti hypertensive drug. Unlike most other ailments, headaches associated with hypertension severely affects concentration and thus chess playing ability. I believe that Capa first became symptomatic in 1924, when he sought medical consult during the New York tournament. Beginning that year, he began missing tactics in his calculations, a tendency that grew worse later in his career.
It's regretful that the greatest genius the chess world has ever produced had to suffer from familial hypertension. At his best I feel that Capablanca's game was the epitome of chess perfection (as close as a human can achieve).
|Jan-13-16|| ||visayanbraindoctor: <Jonathan Sarfati> I just operated on a patient with Kernohan's eye sign. From my forum |
<19M drove his motorcycle into a parked truck 3 days ago in a neighboring province. Comatose, he was referred next day to me. I intubated him in PrH2 ER and transferred him to the public CiH because of lack of family finances. He exhibited the rare Kernohan's sign. He had an acute subdural hematoma on his right hemisphere, yet his left pupil was more dilated than his right (3mm and 2.5mm respectively).>
We discussed Kernohan's sign in the Capablanca page.
|Jan-19-16|| ||Jonathan Sarfati: <visayanbraindoctor>, thanks for that. Seems like patients with Kernohan's have low chance of recovery. Would even a quick op have had a chance with this young motorbike accident victim? I didn't realize that an external injury could produce something similar to the deeply internal injury of a hypertensive cerebral hemorrhage.|
|Jan-21-16|| ||visayanbraindoctor: <Would even a quick op have had a chance with this young motorbike accident victim?>|
Yes, but there was a time delay. He came from a neighboring province that has no Neurosurgeons.
The fastest and cleanest but late brain operation always 'loses' to the slowest and messiest but early one, all other things being equal.
<I didn't realize that an external injury could produce something similar to the deeply internal injury of a hypertensive cerebral hemorrhage.>
Sometimes they do. A trauma may cause basal ganglia hemorrhages, thalamic hemorrhages, mid brain hemorrhages if they damage the same blood vessel whose ruptures are usually associated with hemorrhagic strokes.
More commonly, bleeding caused by trauma results in more superficially located epidural hematomas, subdural hematomas, and lobar hemorrhages.
|Feb-10-16|| ||visayanbraindoctor: <Jonathan Sarfati: Oh dear, so he was basically born with this ticking time bomb in his brain, but the ticks were undetectable unless there had been a reason to perform CT or MRI?>|
I do not know exactly what disease GM Bukavsin suffered from. Based on what I have read from his page, He had a stroke. A stroke below age 40 is regarded as 'stroke in the young', and the most common lethal one is an arterio-venous malformation.
Unfortunately you are right. It's a congenital ticking time bomb in an apparently healthy person. A CT scan usually shows mass of whitish worm-like structures inside the brain.
I see them sporadically and have operated on perhaps a dozen or so (can't recall the exact number anymore). When you open up the brain, you see large abnormal vessels that spurt out blood if you cut them. The book recommends clipping them, and I did so when I was a resident. In my place, there are no clips, but I have found out that cauterizing the feeder vessels carefully with bipolar suffices to control the bleeding. The hard part is to visually expose these vessels properly. If you cut them while they are still buried deep in brain tissue, you will have blood spurting out and painting your field an opaque red. You realize to your horror that you don't know exactly where the bleeding is coming from, and that you can't cauterize what you do not accurately see. You just have to suction the blood as fast as you can and brain tissue as well in order to visually expose the buried vessels, before your patient dies on you of exsanguination. What I do is to suction a bit of brain around the undisturbed vessels in order to visually expose them properly and make sure I don't cut them by accident or carelessness.
As a rule, the patient is young, more males than females, and leading a normal life, often quite active as most young people are. Then they get intolerable headaches, and lose consciousness. In the worst cases, they just drop down unconscious without any warning sign.
If GM Bukavshin, had an AVM, then he could have been one of those who never even made it to the hospital in time for an operation.
|Feb-12-16|| ||visayanbraindoctor: I just did an AVM operation. You could read it up in my forum.|
|Feb-15-16|| ||Jonathan Sarfati: Thanks <visayanbraindoctor>, went and read this. If that family had consented earlier, would the prognosis have been good?|
Referring to another post, any permanent damage to 13M from the delay in getting blood to him?
|Feb-19-16|| ||visayanbraindoctor: < If that family had consented earlier, would the prognosis have been good?>|
Yes I think he would have survived. He has already died. (See latest entry in my forum.)
<Referring to another post, any permanent damage to 13M from the delay in getting blood to him?>
Fortunately, he woke up. It was quite a pleasant surprise. I have discharged him. (See latest entry in my forum.)
|Apr-17-16|| ||GreenLantern: <Jonathan Sarfati: thank you for posting that page.
As I am interested in the game of go/weichi/baduk as well, although not to the same degree as chess, it was interesting to see the similar video go players.>|
You're very welcome <JS> - though I must admit I did not watch the GO video. Unfortunately, I know nothing about the game apart from the fact that it has not yet been taken over by computer engines - which I guess is a good thing ;-)
|Apr-18-16|| ||Jonathan Sarfati: <GreenLantern: Unfortunately, I know nothing about the game apart from the fact that it has not yet been taken over by computer engines - which I guess is a good thing ;-)>|
That was true until a month ago, unfortunately. https://en.wikipedia.org/wiki/Alpha...
|Apr-19-16|| ||GreenLantern: OMG - I had no idea. While I can sympathize with members of the Go community who lament this development, I think it is a remarkable achievement by the AI community. Hopefully, this will lead to more practical applications of this technology. I am not surprised that Google is taking a lead role here, but I guess should no longer be surprised that Facebook is also deeply involved.|
It won't be long before Skynet becomes self-aware ;-)
|May-27-16|| ||visayanbraindoctor: You might want to take a look at my posts in Russian Team Championship (2016)|
In certain genres, it seems to me that some past human performances have remained unsurpassed. These look like empirical observations that directly contradict the assertion that everything in the here and now must be the best, and somehow are progressing into something better.
|Jun-02-16|| ||Jonathan Sarfati: <visayanbraindoctor> Yes, I see that Narcissistic Generation Syndrome has wider application than chess.|
|Jun-29-16|| ||offramp: <onathan Sarfati: <offramp:> No. Have a look at https://www.youtube.com/watch?v=bAd...|
That was possibly the best video I have seen on YouTube this year! Thanks very much!
|Jul-06-16|| ||Jonathan Sarfati: <offramp:> You're welcome. You might like this one as well, the only known film footage with Capablanca speaking. https://www.youtube.com/watch?v=nuy...|
|Jul-15-16|| ||Richard Taylor: Thanks for commenting Jonathan on the chess (The George Trundle). I had a talk with Gary Lane today. He seems a very nice fellow. I told I had his book on the Scotch (he told me he had written 2!) he had the time and kindness to look at two of my games. Mind you he hasn't lost a game in the tournament so is doing well...So he will be in a good mood (so far!).|
|Jul-17-16|| ||Jonathan Sarfati: <Richard Taylor> You're welcome. Were you happy with your final plus score? Shame about the last game; I thought you had compensation because of her split pawns.|
Yes, Gary Lane is a good guy. He and Solo outclassed the rest of the field.
|Jul-18-16|| ||Richard Taylor: Hi Jonathan. I did quite well. I didn't make any major blunders which has been a problem for me. I missed a win against Simon Lyall, but he played a good counter attack. I played a little inaccurately in some games but managed mostly to win.|
In the last game I played too quickly. I cant understand it as I've been in that position at move 9 before. I knew that she could win a pawn so had planned to play 9. Qf3 which is in fact the main move there when Black plays say d5 or Bd6 (Aronian has played that in some games).
But I found myself picking up the B and placing it on g5...incredible! Then I thought, surely it cant be lost at this point but it isn't good. Her K-side pawns were actually an asset. I did think that my f4 move gave some hope...
But my young opponent played well to finish me off! Disappointing finish for sure. I was quite upset. I expected a longer, more even struggle: I had been studying that line just before the game but didn't really think about 'what if Re8'...another move there for White is 9 Re1 which is then = But I think Bg5 is almost a positional loss...But I only looked quickly at it. No one has had much success with it in any case. She studied the board for some time, and then played her moves. Very courageous of her to play that way, and a good result for her.
|Jul-18-16|| ||Richard Taylor: Solomon is a nice fellow also. He gave a good speech last time. And Gary was very supportive. If I was younger I would like to be coached by Gary. He is very supportive and tolerant. They deserved to win...mind you Ben Hague is a good player who might have got there. Also Bruce Watson who is very astute. But he mixed his move order up against Solomon I think. He respects Solomon though: Solomon played a great game last year to beat Bruce!|
|Jul-23-16|| ||Jonathan Sarfati: <Richard Taylor>: well done. Yes, Solo is a good guy too. Ben Hague came after I left NZ so I've never met him, or Kulaskho for that matter. Watson has made a welcome return to chess after many years away, it seems.|
|Jul-24-16|| ||Richard Taylor: <Jonathan Safarti> Watson has been playing consistently (he plays most weeks at the ACC) but plays in only a few tournaments as he mows lawns etc He is one of NZ's best players. He is a very good player. Kulashko has come back the last couple of years to our club. And Ben Hague is a new player who does well in the Grand Prix tournaments. He is still relatively young and is very good. Croad possibly should have done better and Smith played below his capacity. |
Overall it was a good tournament though. I was not sure if I was going to play at all. But I forgot to withdraw and it was better than I thought it would be. Obviously I was annoyed at losing the last game but for my age it was a good challenge! But my rating suffers (well the FIDE rating at least) as I am sure my opponent was closer to my rating than her nominal 1649. However, that is the way of things.
I was lucky against Mukkattu who is quite good but doesn't study perhaps as much as he might...algthough given his result he seems to have put some work into this one.
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