The authors analyzed the results of clinical and angiographical studies of 120 patients with acute severe brain traumas. In 76 cases brain stem lesions were diagnosed during life and in 22 cases diagnosed as a primary lesion. The postmortem data confirmed primary lesion of the stem structures only in 11 cases. The conclusion made by clinicians of the primary stem lesion was based mainly on an impetuously developing picture of stem disturbances during the first hours following trauma. The angiographical data demonstrated that each type of stem lesion in an acute brain trauma has a certain angiographic symptomatology. For a more correct diagnosis the authors recommend to perform cerebral angiography even in a typical clinical picture of primary stem lesion.