title: [Dislocation syndrome in patients with severe massive ischemic stroke].
abstract: OBJECTIVE
  To compare the severity of brain dislocation, the rate of its progression according to CT results and clinical signs of dislocation syndrome (DS) in patients with unfavorable form of massive ischemic stroke (MII).
  
  
  METHODS
  We analyzed the results of examination and treatment of 114 patients with unfavorable course of MII. Patients were stratified by the type of DS course into two groups: group 1 with unfavorable course (91 patients) and group 2 with favorable course (23 patients). Patients were compared by disease course and outcome as well as by progression rate and severity of brain dislocation. Twenty-seven patients of group 1 underwent decompressive craniectomy (DC).
  
  
  RESULTS
  All patients of group 1 had DS decompensation and, therefore DS course was assessed as unfavorable. All patients of group 1, who received only conservative treatment, died from brain dislocation. In patients treated with DC in addition to conservative treatment, the fatality rate was 48%. In this group, we singled out 3 variants of DS course: fulminant, progressive and delayed. In patients of group 2, the fatality rate was 52%. The patients died from non-cranial complications and DS course in this group was regarded as favorable.
  
  
  CONCLUSIONS
  In patients with unfavorable course of MII, the risk of fatal outcome from temporal-tentorial impaction is determined both by the severity and progression rate of transverse dislocation of the middle brain structures. DS in patients with unfavorable course of MII can have favorable or unfavorable course. The unfavorable course is characterized by fulminant, progressive or delayed DS progression rate. The unfavorable course of DS is an absolute indication of administration of DC.
authors.affiliation: City Clinical Hospital #12.
authors.forename: A S
authors.initials: AS
authors.lastname: Nikitin
authors.affiliation: Evdokimov Moscow State Medical Dentistry University, Moscow; Sklifosovsky Emirgency Medicine Institute, Moscow.
authors.forename: V V
authors.initials: VV
authors.lastname: Krylov
authors.affiliation: Central Clinical Military Hospital FSS, Moscow.
authors.forename: S A
authors.initials: SA
authors.lastname: Burov
authors.affiliation: Evdokimov Moscow State Medical Dentistry University, Moscow; Sklifosovsky Emirgency Medicine Institute, Moscow.
authors.forename: S S
authors.initials: SS
authors.lastname: Petrikov
authors.affiliation: City Clinical Hospital #12.
authors.forename: S A
authors.initials: SA
authors.lastname: Asratyan
authors.affiliation: Pirogov Russian National Research Medical University, Moscow.
authors.forename: P R
authors.initials: PR
authors.lastname: Kamchatnov
authors.affiliation: City Clinical Hospital #12.
authors.forename: Yu V
authors.initials: YV
authors.lastname: Kemezh
authors.affiliation: City Clinical Hospital #12.
authors.forename: M V
authors.initials: MV
authors.lastname: Belkov
authors.affiliation: City Clinical Hospital #20, Moscow.
authors.forename: E E
authors.initials: EE
authors.lastname: Zavalishin