头颈外伤致椎动脉破裂伴颅底蛛网膜下腔出血1例尸检分析

头颈外伤致椎动脉破裂伴颅底蛛网膜下腔出血１例尸检分析易旭夫，刘敏，吴家Ｓｕｂａｒａｃｈｎｏｉｄｈａｅｍｏｒｒｈａｇｅｄｕｅｔｏｒｕｐｔｕｒｅｏｆｔｈｅｖｅｒｔｅｂｒａｌａｒｔｅｒｙａｓｓｏｃｉａｔｅｄｗｉｔｈｈｅａｄｔｒａｕｍａ：ｒｅｐｏｒｔｏｆｏｎ...     

Vertebral artery rupture in a sudden death case after mild trauma

We report a case of subarachnoid hemorrhage at the skull base with possible rupture of a vertebral artery, and we present a new method to investigate rupture of this artery. In this method, the brain stem and cerebrum are divided with ligation of the internal carotid artery and basilar artery, and milk is injected from the original part of the vessel to find the rupture. We show that this method is particularly useful for cases of subarachnoid hemorrhage at the skull base in which there may be rupture of a vertebral artery.     

Blunt trauma of the abdomen in children

Abdominal trauma in children is usually due to motor vehicle accidents or falls, but child abuse is also a common cause. Injuries to the small intestine are particularly worrisome because symptoms may not appear for hours, days, or even weeks. This can cause significant difficulty for the investigator trying to determine when an injury occurred, or who may have caused it.     

Traumatic rupture of intracranial vertebral artery due to hyperextension of the head: reports on three cases

In three cases of fatal basal subarachnoid hemorrhage due to rupture of the normal intracranial vertebral artery, the ruptures appeared to have been caused by overstretching of the vertebral artery from traumatic hyperextension of the head. In the first case, that of a 31-year-old male pedestrian who, while intoxicated, had been hit from behind by a car, symmetrically located bilateral complete and incomplete tearing of the vertebral arteries was found. In both of the other two cases, involving women aged 37 and 51 found dead after receiving fist blows to the face while intoxicated, complete rupture of the vertebral artery was found. The blood alcohol concentrations of the three cases ranged from 1.6 to 1.7 mg/g at autopsy.     

Fatal head trauma of an infant. Part II: Biomechanical reconstruction

An 18-month-old child was hit on the head by a falling wooden sculpture (c 60 kg) and sustained a fatal craniocerebral trauma. The kinetics of the trauma could be accurately reconstructed. The child's skull was then modelled using the finite-element-method. The material parameters known from the literature were assigned to the elements. The dynamic reconstruction performed on the basis of the kinetics calculated before was able to reproduce the destruction of the skull and the brain by simulating the impact-related topographical distribution of the intracranial pressure and the von Mises stress field.     

Blunt pancreatic trauma by a wheelchair user restraint system during a traffic accident.

Traffic accidents are the most common cause of blunt pancreatic trauma, and most injuries occur in unrestrained drivers. Blunt pancreatic trauma in a passenger or a restrained driver is rare. In this report, we describe a case of blunt pancreatic trauma caused by a restraint system for wheelchair users during a traffic accident.     

头部外伤后精神损伤的法医学鉴定(附204例分析)

目的　研究颅脑外伤所致精神障碍的损伤程度评定标准。方法　通过对２０４ 例由司法部门委托进行法医学精神损伤程度鉴定实践,重点对颅脑外伤所致神经症的损伤程度评定标准及其他相关问题进行了讨论。结果　２０４ 例中,男、女比例无差异。年龄组以２１ ～３０ 岁（６３ 例） 、３１～４０ 岁（５３ 例） 居多。表明上述年龄组的社会活动多,受到伤害的可能性大;职业以工人、农民为多,文化程度相对较低。损伤原因以伤害（１０７ 例） 、交通事故（４９ 例） 为多。损伤与精神障碍间隔时间,半年以内１５２ 例,半年至１ 年为２３ 例,表明鉴定时间选择在１ 年内为佳。精神障碍的种类与性质：器质性精神障碍１０８ 例,占５２－８％ ;功能性精神障碍８４ 例,占４１－４％ ,其中外伤后神经症（ 含癔症３５ 例）６６ 例,占３２－３ ％ 。社会功能评定：无社会功能受损７７ 例,轻度受损４１ 例,明显受损８６ 例。神经系统检查：２０４ 例中有一过性神经体征３８ 例,有明显阳性体征６２ 例。损伤与精神障碍的关系：直接因果关系１０４ 例、间接因果关系６１ 例;条件相关３４ 例、无相关５ 例。损伤程度评定结果：重伤８５ 例,轻伤６７ 例,伤病关系评定４７ 例。结论　通过对２０４ 例头部外伤     

Sudden and unexpected death resulting from splenic artery aneurysm rupture: two case reports of pregnancy-related fatal rupture of splenic artery aneurysm

Rupture of a splenic artery aneurysm is a rare and usually catastrophic event, most commonly associated with pregnancy. In spite of increasingly common reliance on abdominal angiography, magnetic resonance imaging, and computerized tomography during the past quarter century, clinicians uncommonly recognize any of the various splanchnic arterial aneurysms absent premonitory signs or symptoms. Accordingly, rupture of a visceral aneurysm, including splenic artery aneurysm, typically presents as sudden, unexpected obtundation or death. As a consequence, the initial recognition and diagnosis of splenic artery aneurysm rupture take place only at autopsy. This report presents two such cases of sudden death resulting from splenic artery aneurysm in a pregnant woman and a postpartum woman, respectively.     

Venous air embolism in homicidal blunt impact head trauma. Case reports

From 1992 through 1997, there were 41 deaths by homicidal blunt impact head trauma in Hillsborough County, Florida. Twenty-one cases were excluded from the study because of putrefaction or survival beyond the emergency department doors, leaving 20 cases for the study. One of the 15 nonputrefied victims found dead at the scene and 1 of the 5 victims pronounced dead in the emergency department had definite venous air embolism. Victim 1 was found dead, bludgeoned with a concrete block, and had open vault and comminuted basilar skull fractures. The dura forming the right sigmoid sinus at the jugular foramen was lacerated. A preautopsy chest radiograph and examination under water documented gas in the pulmonary artery and right ventricle. Victim 2 was bludgeoned with a steel stake and was pronounced dead on arrival in the emergency department. He had open comminuted vault fractures, a transverse basilar skull fracture, and lacerations of the brain. Direct examination and preautopsy chest radiography revealed air in the right side of the heart. A third victim, with basilar fractures, had a small gas bubble in the pulmonary artery not detected by the case pathologist. A fourth victim, with a basilar skull fracture, had an unusual radiographic finding that was thought to be air in the posteromedial aspect of the lower lobe of the left lung but could not be excluded as an air embolus. Optimal postmortem documentation of venous air embolism includes the demonstration of the embolus and the site of air ingress. This study demonstrates that venous air embolism occurs in some victims of homicidal bludgeoning and suggests that when significant, it is easily demonstrated in the absence of putrefactive gas formation. The presence of venous air embolism can serve as evidence that a victim was alive and breathing at the time of the infliction of head wounds. In the belief that venous air embolism might be underdiagnosed in many medical examiner offices, the authors have sought to bring attention to the entity by publishing their experience with it in cases of bludgeoning.     

头部外伤后精神损伤的法医学鉴定(附204例分析)

目的研究颅脑外伤所致精神障碍的损伤程度评定标准.方法通过对204例由司法部门委托进行法医学精神损伤程度鉴定实践,重点对颅脑外伤所致神经症的损伤程度评定标准及其他相关问题进行了讨论.结果 204例中,男、女比例无差异.年龄组以21～30岁(63例)、31～40岁(53例)居多.表明上述年龄组的社会活动多,受到伤害的可能性大;职业以工人、农民为多,文化程度相对较低.损伤原因以伤害(107例)、交通事故(49例)为多.损伤与精神障碍间隔时间,半年以内152例,半年至1年为23例,表明鉴定时间选择在1年内为佳.精神障碍的种类与性质:器质性精神障碍108例,占52.8%;功能性精神障碍84例,占41.4%,其中外伤后神经症(含癔症35例)66例,占32.3%.社会功能评定:无社会功能受损77例,轻度受损41例,明显受损86例.神经系统检查:204例中有一过性神经体征38例,有明显阳性体征62例.损伤与精神障碍的关系:直接因果关系104例、间接因果关系61例;条件相关34例、无相关5例.损伤程度评定结果:重伤85例,轻伤67例,伤病关系评定47例.结论通过对204例头部外伤后精神损伤鉴定实践,对当前法医学精神损伤鉴定的疑难问题,如颅脑外伤所致神经症的损伤程度评定标准,提出了具体的可操作性的意见,以期在实践中进一步深入研究.     

The relationship of closed-head trauma to rupture of saccular intracranial aneurysms

It is often asserted, especially in worker's compensation cases, that blunt trauma or work-related physical exertion can be responsible for the rupture of a preexisting saccular intracranial aneurysm. However, a critical review of the literature and extensive personal experience indicates no or at best a very weak relationship between blunt closed-head trauma and the rupture of a preexisting saccular intracranial aneurysm. This report is based on a 19-year study of the effects of trauma on aneurysms in a clinical and autopsy-derived population.     

Sudden death in an infant caused by rupture of a basilar artery aneurysm.

Ruptured aneurysms of the cerebrovasculature in infancy and early childhood, except for "giant" aneurysms and arteriovenous malformations, are rare. Seizures, loss of consciousness, and apnea are the usual presenting signs in infancy; symptoms such as headache or visual disturbances and signs such as cranial nerve compression or meningeal irritation commonly found in older children or adults are absent in infants. However, the morphologic findings (i.e., subarachnoid and retinal hemorrhage, and occasionally subdural hemorrhage) may be mistaken for inflicted trauma, especially if the aneurysm is not identified. Sudden death caused by rupture of a cerebral aneurysm has not been previously described in an infant. This report outlines the investigation and autopsy findings in a 7-month-old infant who died unexpectedly as a result of rupture of a complex basilar artery aneurysm.     

Death related to coronary artery fistula after rupture of an aneurysm to the coronary sinus.

Large coronary fistulas are considered to cause myocardial ischemia due to diversion of the coronary blood flow. In this case the authors report the reverse effect--the spontaneous closure of a large fistulation between the left circumflex artery and the coronary sinus evoked angina pectoris in a middle aged man, who died several years later. Postmortem examination revealed a coronary aneurysm that had ruptured and dissected into the coronary sinus and finally thrombosed. The origin of the aneurysm could be congenital but perhaps also represents a healed stage of Kawasaki disease.     

Traumatic rupture of the basilar artery: report of two cases and review of the literature

Two cases of traumatic rupture of the basilar artery are reported. In the first case, severe basal subarachnoid hemorrhage (SAH) due to a complete transverse tear of the basilar artery was observed in a 53-year-old restrained male driver who was involved in a head-on collision while intoxicated and drowsy. He lost consciousness shortly after the accident and was admitted to hospital in cardiopulmonary arrest. Intensive resuscitative therapies produced cardiac response, but he died 50 minutes after the accident. The ethanol concentration in his blood and urine was 0.35 and 0.55 mg/ml, respectively. In the second case, SAH due to a similar tear of the basilar artery was observed in a 47-year-old man who received several fist blows to the face while intoxicated. He suddenly lost consciousness after the final blow and was admitted to hospital in cardiopulmonary arrest. Intensive resuscitative therapies produced cardiac response, but he died 6 hours after the event. In these cases, the mechanism of the traumatic rupture of the basilar artery is thought to be overstretching due to hyperextension of the head, and intoxication, drowsiness, or both may have interfered with the decedents' ability to protect themselves; thus, the hyperextension of the head may have been rather forceful.     

Peculiarities of the forensic medical expertise of the head trauma in children

One hundred and forty (140) medicolegal reports were analyzed in cases of non-lethal trauma of the head in children and teenagers. The specificity of the clinical pattern related with the anatomic-and-physiological peculiarities of child's body was defined. The forensic-medical expertise in such damages needs an elaboration of diagnostic criteria (e.g. an interim stage in craniocerebral trauma) that would be valuable both for medico-legal experts and for neurologists; besides, there is also a need in using the modern methods of neuro-visualization.     

Cerebral tissue pulmonary embolization due to head trauma: a case report with immunohistochemical confirmation

Pulmonary embolization of cerebral tissue as the result of severe head trauma is an uncommon, if not rare, phenomenon, and few cases have been reported in the literature. The authors discuss the case of a 51-year-old male who died six days after suffering extensive head trauma in a motor vehicle collision. At autopsy, white-gray emboli were found in several subsegmental pulmonary arteries. The results of histologic examination with the hematoxylineosin stain gave the impression that the emboli were necrotic cerebral tissue; however, routine special stains for neural tissue produced inconclusive results. Immunohistochemical staining of the emboli with monoclonal mouse anti-human neurofilament protein (Dako Corp., Carpinteria, California) confirmed the cerebral nature of the emboli. To the authors' knowledge, this is the first reported case of pulmonary embolization of cerebral tissue confirmed by immunohistochemistry.     

Sudden death due to delayed rupture of hepatic subcapsular hematoma following blunt abdominal trauma

Blunt abdominal trauma can cause sudden, unexpected death due to injuries to internal organs. Rupture of a hepatic subcapsular hematoma is a relatively rare cause of sudden death following minor blunt abdominal trauma. Death may be delayed several days to weeks. The autopsy is an invaluable diagnostic tool that can be utilized to uncover sudden deaths due to abdominal trauma. The case of an alcoholic who died of a ruptured hepatic subcapsular hematoma is presented. The death investigation revealed that the victim had sustained blunt abdominal trauma during a fall a few days prior to death.     

Heimlich trauma: a violent maneuver.

The Heimlich maneuver is a life-saving technique for dislodging foreign material from the respiratory tract. This report illustrates intraabdominal injuries, including a large mesenteric laceration, mesenteric contusions, and intraperitoneal hemorrhage, that occurred in a recipient of a vigorously applied Heimlich maneuver. The potential for confusing such injuries with homicidally inflicted injuries is emphasized.