颈内动脉系钝性损伤法医学鉴定现状

颈内动脉系是大脑的主要血供来源。法医学鉴定实践中,颈内动脉系钝性损伤后常出现血栓、动脉瘤或动静脉瘘等并发症,由此引起迟发性脑梗死、颅内出血死亡的案例并不少见。目前国内对颈内动脉系钝性损伤引起死亡的研究以个案报道为主,本文综合国内外相关的文献及案例报道,对此类损伤引起死亡的法医学特点及检查方法进行总结,发现颈内动脉系钝性损伤与头颈部直接暴力或间接暴力致头颈部超生理范围运动牵拉,以及颅底骨折切割等机制有关,多见于颈部机械性窒息、颈部按摩、车祸、高坠等案例。法医学实践中若遇到此类案例,常规检查未发现梗死或出血原因,应注意检查该动脉,正确分析外伤、疾病和死亡之间的关系。鉴于尸体解剖中完整暴露该动脉的难度较大,必要时可借助血管造影技术进行定位,提高鉴定意见的科学性和可靠性。     

颅脑损伤致死而头皮无损伤3例

法医尸体检验鉴定中,头部受强大的钝性外力作用下头皮裂伤,颅脑严重损伤致死案例较多见,其中个别案例头部虽受较大的钝性外力作用造成颅脑严重损伤致死,但头皮肉眼观未见损伤,其成伤机制值得分析研究.本文就此问题提出讨论.     

螺旋形骨折成伤机制分析的法医学意义

<正>螺旋形骨折并非发生于外力作用点的损伤,其成伤机制有多种方式,依据成伤机制不同可以分为意外、过失和故意伤害等,准确判断螺旋形骨折的成伤机制对案件的后期处理至关重要。本文结合实际案例,对螺旋形骨折的成伤机制进行探讨,为法医临床学鉴定提供参考。1螺旋形骨折形成机理在一定程度的外力作用下,骨骼组织任何部位的连续性、完整性遭到破坏,便可造成骨折。不同性质的外力可以造成不同的骨折形态,管状骨骨折形态分为     

闭合性胸部损伤致心肌挫伤、坏死并破裂的法医学鉴定

心脏损伤是指外力引起心脏结构及功能障碍，可分为钝性伤和穿透性伤两类。实际工作中穿透性心脏损伤多见于锐器和火器损伤，损伤容易被发现和鉴定。而钝性心脏损伤又称闭合性心脏损伤，比较隐匿,检查和鉴定有一定困难，必须进行详细的尸体解剖和病理学检验。本文结合一案例讨论如下：     

桡骨远端骨折成伤方式分析1例

<正>骨折的成伤方式或者成伤机制分析在损伤程度鉴定中是必要的，甚至是不可或缺的，具有重要价值^[1]。文献有关于颅脑损伤^[2]、颅底环状骨折^[3]和肋骨骨折^[4]等致伤方式、成伤机制的报道，提示不同部位骨折成伤机制的分析对还原案件事实、判断案件性质具有直接的证据价值。本文报道一例以桡骨远端骨折的形态特征来分析成伤方式、重现致伤过程的案例，为办案机关查明事实、解决纠纷、公平公正处理案件提供了重要依据。     

钝性外力致易复性腹股沟斜疝嵌顿引起迟发性肠穿孔1例

外伤致腹股沟嵌顿疝文献中有案例报道 ,但钝性外力致易复性腹股沟斜疝嵌顿引起迟发性肠穿孔案例报道较少 ,本例因涉及到损伤与疾病的因果关系和损伤程度鉴定 ,现予报道。1　案例简介蔡某 ,男 ,74岁 ,农民。 2 0 0 2年 8月 8日因口角被他人用足踢伤左会阴部 ,伤后剧痛难忍 ,左腹     

牙齿损伤的致伤方式法医学鉴定3例

<正>在伤情鉴定工作中，外伤致牙损伤情况比较常见，但牙损伤涉及损伤机制如造作伤、诈伤以及伤病关系分析等，给部分牙损伤程度的评定带来了一定困难。笔者在实践中遇到多例攻击他人时造成自身牙损伤的案例，本文报道3例牙齿损伤鉴定案例，旨在对外力直接作用致牙损伤的特点与机制进行探讨。1案例资料1.1手指挣脱致牙损伤     

寰枢关节半脱位法医学鉴定25例分析

随着社会经济尤其是现代交通工具的迅猛发展,颈部损伤有日趋增多的现像。据报道颈椎寰枢关节损伤在成人颈椎损伤中占16%,而在儿童高达70%。本文归纳总结了25例寰枢关节损伤案例,就其致伤机制、症状体征、影象学特征、损伤程度鉴定等方面进行讨论,有助于进一步规范此类损伤的法医学鉴定。1案例资料1.1一般情况本文收集了上海市公安局损伤鉴定室1998年至2002年间所受理的25例外伤后诊断为寰枢关节半脱位的案例。所有案例均通过X线和CT检查。经我室鉴定后,明确为半脱位的仅16例,否定9例。否定率之高,提示法医工作者在遇到寰枢关节半脱位的鉴…     

扼颈损伤的法医临床学鉴定21例分析

目的分析总结扼颈损伤的一般规律,归纳损伤程度鉴定的要点,为法医临床学司法鉴定实践及制定、修改相关鉴定标准的条款提供参考。方法对襄樊地区1963年1月—2004年1月因扼颈致伤的案例,按性质、症状、鉴定结论进行总结和分析。结果颈部扼伤加害者多为青壮年男性,加害者身上多有抵抗伤;被害人颈部多有扼痕反应,主要症状、体征以喉挫伤、眼部窒息征象表现为主。结论损伤程度以轻伤与轻微伤为主,现行鉴定标准有一定的不适应性。     

钝性物体击碎镜片致眼损伤鉴定6例分析

眼损伤是法医临床工作中经常遇到的问题,其中戴眼镜的人眼部遭受暴力后,碎裂的镜片致眼损伤后果较为严重。现就近年来我处及包头市公安局120余例眼损伤中,6例涉及该方面内容的案例进行讨论。案例资料一、鉴定资料(见表1)表1　6例钝性物体击碎镜片致眼损伤鉴定资料序号损　　　伤钝性致伤物眼别鉴定时最佳矫正视力　ＯＤ　　　　　　ＯＳ　鉴定时限损伤程度1眼睑穿通伤,角、巩膜裂伤,网脱拳　头右0021022月重伤2角膜裂伤、擦伤砖　头右指数/眼前052月重伤3睑裂伤,瞳孔散大,黄斑病变拳　头右02056ｄ轻伤4角膜穿通伤,虹膜粘连,瞳孔散大,白内障…     

Delayed left anterior and middle cerebral artery hemorrhagic infarctions after attempted strangulation: a case report

The 2 common carotid arteries bifurcate in the neck into the internal and external carotid arteries. The internal carotid artery enters the skull and further divides into the anterior and middle cerebral artery. During its short course in the neck, the carotid artery travels encased in the carotid sheath along with the vagus nerve and the internal jugular vein. During its course in the neck, the carotid artery is quite superficial, making it vulnerable to both penetrating and blunt traumatic injuries. We report here a case of a 40-year-old man who presented to the emergency department after sudden collapse and loss of consciousness a day after an attempted strangulation. Imaging revealed large hemorrhagic infarcts in the left anterior cerebral artery and middle cerebral artery territories as well as a smaller infarcts in the right anterior cerebral artery territory necessitating emergency decompressive hemicraniectomy. Our case report adds to the existing literature on nervous system injury due to strangulation. Physicians should be aware of the possibility of delayed presentation of neurological deficit after attempted strangulation.     

Amussat’s Sign in Hanging—A Prospective Autopsy Study

Abstract: Amussat’s sign is typically a transverse laceration of the intimal layer of carotid arteries described in cases of hanging. Subtotal laceration of the carotid artery is not strictly specific for hanging and can be also caused by blunt neck trauma, extreme overstretching, or whiplash‐injuries. In a prospective autopsy study of 178 cases of hanging, Amussat’s sign was found in 29 cases (a relative frequency of 16.1%). A statistically significant association between the occurrence of tears in the intimal layer of carotid arteries and the victims’ age was discovered in the cases studied (the frequency increased with age; p < 0.05). The occurrence of Amussat’s sign was independent of gender, weight, completeness of the victim’s body suspension, and position of the ligature knot on the neck. The study demonstrates the fact that the most probable cause of Amussat’s sign is a combination of direct compression of the artery by the rope and indirect stretching because of the gravitational drag produced by the weight of the body.     

A Fatal Leopard Attack

Abstract: A rare case of a big cat fatal attack is presented. A male leopard that had escaped from its unlocked cage attacked a 26‐year‐old male zoo worker. The man sustained penetrating injuries to the neck with consequent external bleeding. The man died while being transported to the hospital as a result of the injuries sustained. The wounds discovered on the victim’s body corresponded with the known methods of leopard attacks and with findings on the carcasses of animals killed by leopards in the wild. The conclusion of the medicolegal investigation was that the underlying cause of death was a bite wound to the neck which lacerated the left internal jugular vein, the two main branches of the left external carotid artery, and the cervical spine. The cause of death was massive external bleeding. Special attention is paid to the general pattern of injuries sustained from big cat attacks.     

Suicide by a circular saw

The case of a suicide of a 32-year-old female using an electric circular saw is herein described. The decedent was suffering from depression and was found dead in her room. Beside her right hand was lying a circular saw, which was not running. The autopsy revealed a large gaping wound measuring 15.5 cm in length on the right side of her neck. The right external carotid artery, the right internal jugular vein, and the right internal carotid artery were cut and the injury reached to the cervical vertebra. Therefore, the cause of death was exsanguination. An individual who commits suicide with an electric saw, such as a chain saw, band saw, and circular saw is rare; in particular females rarely select this method as the means of suicide. However, we herein report the case of a female patient with a psychiatric disease who successfully committed suicide with a circular saw.     

Fatal dissecting aneurysm of the internal carotid artery with delayed symptoms following facial impact.

A fatal dissecting aneurysm of the internal carotid artery occurred in a 16-year-old male following facial impact in an automobile accident. The patient showed no neurologic deficit until two days after the automobile accident, when he suddenly started having seizures and developed right-sided hemiparesis. There was no evidence of direct trauma to the neck externally or internally. The only injuries observed in the head and face were two skin lacerations in the chin area. His condition rapidly deteriorated, and he expired on the fourth hospital day. The gross and microscopic findings for the internal carotid artery are presented. The possible mechanisms for the vascular lesion and a review of the literature are discussed.     

Fatal thrombosis of internal carotid artery following minor blunt trauma to the neck

Fatal traumatic thrombosis of the left internal carotid artery occurred in a 38-year-old man following minor blunt cervical trauma during an altercation. There was no external injury observed on the head, face, or neck. Neurologic deficit developed soon after the injury, which progressed to right hemiplegia. His condition deteriorated and he expired on the sixth hospital day. The gross and microscopic findings of the internal carotid artery are presented and the significance of minor cervical blunt trauma and the possible mechanism for the vascular lesion are discussed.     

Traumatic bilateral vertebral artery dissection

Traumatic vertebral artery dissection is not often seen by forensic pathologists, and cases investigated are scarce in the forensic literature. We present the case of a 40-year-old woman cyclist who was struck by a car while wearing a helmet, and was neurologically near normal immediately thereafter at Emergency. She presented 48 h later with acute right hemiparesis, decreasing level of consciousness, and unsteadiness. CT revealed massive cerebellar infarction. CT angiography was normal. The patient died in coma 7 days after injury and autopsy revealed bilateral edematous cerebellar infarction and bilateral vertebral artery dissection. Rotational neck injury and mural tear in the wall of the Atlantic parts of both vertebral arteries is suggested as the possible mechanism of the arterial injury. Head and neck injuries are reported as a precipitating cause of vertebral artery injury. The possible influence of trauma may be further underestimated if longer intervals between vessel dissection and ischemia occur. The current case illustrates that "talk-and-die" syndrome may be due to occult vertebral artery dissection, possibly bilateral. In forensic cases of delayed death after mild trauma to the head and neck, the vertebral arteries should be examined for the cause of death.     

An uncommon delayed sequela after pressure on the neck: an autopsy case report

Delayed sequelae after pressure on the neck are rare. Awareness of such sequelae as well as a high degree of suspicion is essential for early detection and proper clinical management. Injuries to the common carotid artery and pseudo aneurysm formation leading to fatal hemorrhage are still rare occurrences after attempts of manual strangulation. When such cases are presented to the forensic pathologist, he has to establish the link between the cause and effect, excluding other possible causes for such complications. In addition, he may have to give opinions in possible medical negligence charges.     

玻璃刺创形态学特点的初步研究

目的研究玻璃刺创的形态学特点。方法分别用3个厚度为0．31cm带尖状突起的啤酒瓶残端及3块厚度为0．29cm有尖的普通窗玻璃碎片按设定的不同方向刺击带皮猪肉组织,重复此过程3次,形成198例创口,观察、编号、拍照、测量各创口。结果198例创口的整体形态可分为5种类型,即“工”型、“”型、“”型、“上”型与“一”型,各型在不同刺击方向的分布上存在差异,其中前4种为主要类型,共约占总数的93％,其共同点为在损伤的中部出现了一段与损伤整体走向垂直的创口,啤酒瓶残端所致垂直创口的长度为0．31±0．Olcm（x±s）,窗玻璃碎片所致垂直创口的长度为0．29±0．Olcm（x±s）。结论损伤中部有与损伤整体走向垂直的短创口是玻璃刺创中易出现的一种形态学特点,垂直创的长度与致伤玻璃的厚度具有一致性。