A clinico-morphological analysis of the traumatic substrates to cerebral injuries in different inertial loads on the brain]

The relationships between the inert tension of the head and the morphologic substrates of brain injuries were under study. A comparative clinical and morphologic analysis of lethal contusion and axonal injuries underlie this investigation. Differences in the neurologic semeiotics and CT data in such injuries are presented. The authors discuss the mechanisms of the physical processes in the skull, resulting in focal and diffuse injuries of the brain. Quantitative assessment of the traumatic cerebral substrates is given and relations of these parameters to the conditions of the head trauma (the direction of the external injurious factor action) and the clinical picture are shown. The results of this study may be useful in establishing some circumstances of craniocerebral injuries.     

The forensic medical assessment of the micromorphology of brain stem hemorrhages in craniocerebral trauma

Microscopic features of primary and secondary hemorrhages in the stem portion of the brain in craniocerebral injuries are described. Criteria of differential diagnosis between primary and secondary hemorrhages in the stem in subjects dead during 24 h after isolated and combined craniocerebral injuries are defined. The forensic medical significance of differential diagnosis of hemorrhages in the stem for the solution of many expert problems is evaluated.     

Diagnostic evaluation of main signs of liquor crystallograms in live subjects with craniocerebral injuries of different severity

Liquor samples from 159 live subjects with craniocerebral injuries were analyzed. Forty-four patients had brain concussions, 30 light contusions of the brain, 43 medium-severe contusions of the brain, and 42 severe contusions of the brain. Crystallograms were evaluated by 37 signs detected visually and by stereoscopy. The main diagnostic criteria for evaluation of the severity of craniocerebral injury were defined.     

Histo-morphological findings at the chiasma opticum in cases of craniocerebral trauma (author's transl)]

36 cases with pituitary haemorrhages were found histologically in 52 cases of lethal craniocerebral trauma. Simultaneously we found primary and secondary traumatic changes of chiasma opticum in 10 cases. The genesis and significance of the results are discussed.     

Fall from height--surprising autopsy diagnosis in primarily unclear initial situations

External post-mortem examination and first police assessments are often not consistent with subsequent autopsy results. This is all the more surprising the more serious the injuries found at autopsy are. Such discrepancies result especially from an absence of gross external injuries, as demonstrated by four examples. A 42-year-old, externally uninjured male was found at night time in a helpless condition in the street and died in spite of resuscitation. Autopsy showed severe polytrauma with traumatic brain injury and lesions of the thoracic and abdominal organs. A jump from the third floor was identified as the cause. At dawn, a twenty-year-old male was found dead on the grounds of the adjacent house. Because of the blood-covered head the police assumed a traumatic head injury by strike impact. The external examination revealed only abrasions on the forehead and to a minor extent on the back. At autopsy a midfacial fracture, a trauma of the thorax and abdomen and fractures of the spine and pelvis were detected. Afterwards investigations showed that the man, intoxicated by alcohol, had fallen from the flat roof of a multistoried house. A 77-year-old man was found unconscious on his terrace at day time; a cerebral seizure was assumed. He was transferred to emergency care where he died. The corpse was externally inconspicuous. Autopsy revealed serious traumatic injuries of the brain, thorax, abdomen and pelvis, which could be explained by a fall from the balcony. A 47-year-old homeless person without any external injuries was found dead in a barn. An alcohol intoxication was assumed. At autopsy severe injuries of the brain and cervical spine were found which were the result of a fall from a height of 5 m. Conclusion: On the basis of an external post-mortem examination alone gross blunt force trauma cannot be reliably excluded.     

Morphologic changes in spinal cord of patients with spinal injuries who died in hospital

Morphologic changes in the spine have been investigated in patients with spinal injuries who died in hospital. The incidence of injuries has been evaluated as 9.3% of mechanical injuries. Purposeful search for possible injuries increased the rate of detection of injuries of the spine and the cord. Spinal cord can be impaired without involving the osseous formations and spinal ligaments. Edema of the cord tissue develops during the early period of injury and prevents the detection of injuries, persisting for a long time after the injury. Edemas are detected even in subjects who died at the site of accident.     

Comparative characteristics of hydration distribution in various structures of the brain in the deceased of a severe cerebrocranial trauma

Hydration in the brain structures was analysed in 34 victims who had died of a severe craniocerebral trauma with pathological processes (hematoma, foci of brain crushing) of different location. Some of the patients had undergone open operations on the brain. Mosaic distribution of water was revealed in various structures of the brain where normohydration and dehydration occurred more often than hyperhydration.     

Peculiarities of combined blunt head injuries in children and adolescents

The objective of the present study was to evaluate the frequency and peculiar features of combined head injuries in children and adolescents who suffered the fatal blunt trauma. A total of 101 corpses and 188 archive records were available for the analysis. The control data group was comprised of 227 original observations of adult corpses. It was shown that head injuries prevail over injuries to other parts of the body in children with combined blunt traumas. The craniocerebral injuries are more frequent in children and adolescents than in adult subjects but their extent is smaller. Fractures of the facial bone skeleton in adults occur twice as frequently as in children. A peculiar feature of craniocerebral injuries in children and adolescents is incomplete splintered fractures and folded deformation of the bone plate. Subarachnoidal hemorrhage occurs equally frequently in children and adults with craniocerebral injuries. Other intracranial manifestations of the injury, such as ruptured brain tunics, epidural and subdural hemorrhage, cerebral contusion and ventricular hemorrhage in children occur less frequently than in adults.     

颅脑损伤患者智能和记忆损害的相关因素研究

目的探讨交通事故所致颅脑损伤伤者的智能和记忆损害及相关因素。方法 统计分析成都市1999年1月1日至2001年12月31日间因交通事故造成颅脑损伤的652例伤者的心理测验、脑电图及脑影像学资料。结果研究组平均智商为77.85±15.97,27.9％的伤者智商低于70;51.9％的记忆商低于51。智力损害与文化程度、左颞叶损伤、≥3个脑叶损伤以及脑电图异常明显相关;记忆损害与文化程度、损伤和鉴定检查的间隔时间、脑于损伤、左颞叶损伤、脑电图异常明显相关。结论交通事故造成颅脑损伤的伤者多有不同程度的智力和记忆损害,且与左颞叶损伤、脑电图异常、文化程度、脑干损伤等因素有关。     

脑外伤所致精神障碍的影响因素

目的 对脑外伤所致各种精神障碍的发生率、表现形式及影响因素进行相关性研究.方法 以淮南市精神病医院近5年来进行医学鉴定的脑外伤所致各种精神障碍患者共388例为研究对象,在距脑外伤后6个月至1年内由至少3名精神科医师根据"中国精神疾病分类方案与诊断标准(第2版修订本)"(CCMD-2-R)对他们的精神状态进行评估.结果 (1)脑外伤所致精神障碍中智力障碍的发生率为74.2%,以轻度以下的智力障碍为主.(2)颅内血肿、脑干损伤、脑损伤范围、格拉斯哥分度量表评分(GCS)、合并精神障碍及文化程度对智力损伤程度的影响较大.(3)脑干损伤、颅内血肿、GCS、脑损伤范围、昏迷时间与有无智力障碍关系密切;脑损伤范围、脑挫裂伤、额叶损伤、颅内血肿与精神病性症状关系密切;额叶损伤、开颅治疗、颅内血肿与人格改变关系密切.结论 在颅脑创伤所致精神障碍的鉴定中,应结合颅脑创伤的性质,全面评估其精神状态.     

The pathomorphological characteristics of the vascular plexuses and ependyma of the cerebral ventricles in human craniocerebral trauma]

The morphology of the studied substrates was analyzed in lethal craniocerebral injuries of various origins and in various periods after it was suffered. The data on the pattern and time course of pathomorphologic shifts and functions extend the general notions on the role of the liquor circulation system in the pathogenesis of craniocerebral injury. These results may serve as additional expert criteria of the mechanisms of brain injury.     

脑电图在轻度精神伤残评定中的运用价值

目的探索脑电图(electroencephalogram,EEG)在脑外伤所致精神障碍者轻度精神伤残评定中的应用价值。方法入组符合ICD-10脑外伤所致精神障碍的诊断标准,进行精神伤残评定的271名。使用日常生活能力量表(Activity of Daily Living Scale,ADL)、功能活动调查表(Functional Activities Questionnaire,FAQ)、社会功能缺陷筛选量表(Social Disability Screening Schedule,SDSS)进行评估,完成韦氏智力测验及EEG检查。结果 215名患者完成研究。格拉斯哥昏迷指数(Glasgow Coma Scale,GCS)、脑外伤的严重程度、FAQ、SDSS及ADL总分在EEG异常程度不同的患者之间差异有统计学意义(P0.05),EEG异常程度不同者在精神伤残等级之间差异有统计学意义(P0.05)。结论 EEG可以反映脑外伤的严重程度,辅助评估脑外伤所致精神障碍者社会功能及日常生活能力,并较为有效地区分轻度精神伤残等级,在精神伤残评定中具有一定的参考价值。     

Modern aspects of forensic medical diagnostics of the craniocerebral injury

The authors report the results of the investigations of craniocerebral injuries (CCI) including crystallographic studies of brain liquor obtained after the injury and non-traumatic pathological processes. The additional forensic medical criteria for the severity of craniocerebral injuries have been developed and the objective signs of CCI determined to be used for diagnostic purposes in the cases with concomitant diseases and also in the subjects of advanced and declining age. The diagnostic methods for the elucidation of the nature of chronic subdural hematomas and the estimation of the time of their formation have been improved.     

Evaluation of disorders in the liquor circulation in craniocerebral trauma

The modern methods of complex examinations of the brain in craniocerebral trauma are addressed and the possibilities of the topographic-and-anatomic substantiation in the forensic-medical (expert) evaluation of traumatic lesions of liquor-circulation structural elements are elucidated in the paper. Morphometry data characterizing the dislocation manifestations are presented with respect to the dislocation intensity and severity.     

Vital reactions in Pacchioni granulations

By means of histological methods the authors examined the blood and fluid circulatory disturbances associated with cranial and cerebral injuries. The presence of vital reactions was studied by means of the combined histological study of the dura mater, pacchionian granulations and the central nervous system. Samples for histological study were taken from 115 cadavers who had suffered cranial injuries, from 15 individuals who died from destructive cerebral apoplexy caused by a disease and from 30 individuals who died of natural causes. The authors applied a special fixation and sampling technique and, using various histological reactions, the following vital reactions were observed: the appearance of blood-cell elements in the granulation, a moderate fibrin degradation product and hemoglobin phagocytosis, and occasionally lipid phagocytosis. The authors worked out a method that was shown to be highly effective in the more precise determination of the induction time of cerebral apoplexy caused by a disease and that of traumatic injury of the brain.     

A fatal elephant attack

A rare case of an elephant attack is presented. A 44-year-old man working as an elephant keeper was attacked by a cow elephant when he tripped over a foot chain while the animal was being medically treated. The man fell down and was consequently repeatedly attacked with elephant tusks. The man sustained multiple stab injuries to both groin regions, a penetrating injury to the abdominal wall with traumatic prolapse of the loops of the small bowel, multiple defects of the mesentery, and incomplete laceration of the abdominal aorta with massive bleeding into the abdominal cavity. In addition to the penetrating injuries, the man sustained multiple rib fractures with contusion of both lungs and laceration of the right lobe of the liver, and comminuted fractures of the pelvic arch and left femoral body. The man died shortly after he had been received at the hospital. The cause of death was attributed to traumatic shock.     

Pathomorphological study in craniocerebral injury

Time course of the posttraumatic process in craniocerebral injuries is analyzed. Pathomorphological picture of changes in soft tissues of the head, meninx, and brain matter are described. Several periods are distinguished. Factors affecting the course of the posttraumatic process in the above-mentioned structures are discussed.     

实验性脑挫伤后caspase-3表达的免疫组织化学研究

目的 观察大鼠在不同程度及不同时间脑挫伤后caspase-3表达的变化。方法 对48例实验性脑挫伤大鼠的脑组织进行检验,同时以10例非脑挫伤的脑组织做对照。结果 伤后1h,caspase-3即有表达;24～48h达高峰,2周时仍有阳性细胞存在。阳性细胞多集中于挫伤区及周围带皮质和脑实质内海马区;不同程度脑挫伤组之间于伤后1h,12h,24h,72h,1周和2周caspase-3表达有差异。结论 不同程度脑损伤后caspase-3表达量不同;在脑损伤后caspase-3的表达有时间变化规律,对探讨脑挫伤后二次损害原因和研究脑挫伤程度有一定意义。     

Cardiopulmonary resuscitation-related injuries and homicidal blunt abdominal trauma in children

Defendants accused of inflicting fatal abdominal injuries to children occasionally raise the defense that the injuries were caused by cardiopulmonary resuscitation (CPR). The purpose of this study is to answer the question: Does closed chest CPR result in fatal blunt abdominal injuries that can be mistaken for homicidal assault? To that end, a retrospective study was conducted of all homicidal blunt abdominal injuries in children 10 years and younger from the Dade, Broward, and Palm Beach Medical Examiner's Offices from 1981 through 1997. These were compared to cases of children who died of natural causes during the same time period in Broward County who had CPR (control group 1) and to children who died of nonvehicular accidental blunt abdominal trauma (control group 2). Children with life-threatening head injuries were excluded. Medical examiner records, autopsy reports, documenting photographs, and clinical records were reviewed. The data analyzed included subject demographics, whether CPR was performed and by whom, and autopsy findings. Thirty-three child homicides with fatal abdominal injuries were reviewed. Twenty-four (73%) of the homicides received CPR. There was no difference in the nature and severity of injuries between the 24 children who received CPR and the 9 who did not. Three hundred and twenty-four cases of pediatric natural deaths were reviewed, all of which had CPR. No traumatic abdominal injuries were found in any of the children who died of natural causes. Only four children who died of natural causes had evidence of extraabdominal trauma related to CPR. No cases of nonvehicular accidental blunt abdominal trauma were identified during the 17-year period, although there were nonvehicular accidental fatalities due to extraabdominal injuries. The likelihood of CPR-related primary abdominal trauma in child homicides is very low.     

Micromorphological criteria of the early periods in craniocerebral trauma]

System of quantitative criteria for early periods of craniocerebral trauma involving short intervals (0-5 min, 0.5h, 1-2h, 3-4h, 5-6h) was developed on the basis of micromorphometric study of the brain obtained from 120 persons who died of craniocerebral trauma. High informative value of morphometric characteristics of vagus dorsal nucleus (values of neurocyte quantity, disorientation and deformity; percentage of cells without visible changes and different pathomorphologic types; excess coefficient; coefficient of correlation between volumes of neuron bodies and nuclei; nucleus volume) was determined. Optimal conditions of using quantitative criteria were outlined.