36例脑血管畸形猝死案例及法医病理学分析

目的探讨脑血管畸形猝死的法医病理学特点和检查方法。方法对1997年至2006年10月四川华西鉴定中心所做36例脑血管畸形猝死病例进行分析。结果脑血管畸形猝死以10~49岁男性为主,有25例(69.44%)。18例(50%)发病前有明显诱因。18例(50%)在发病后1h内迅速死亡。脑血管畸形猝死的病理类型以脑动静脉畸形最为常见,有33例(91.67%)。24例(66.67%)发生于脑底部、桥脑和小脑。破裂出血是脑血管畸形猝死的直接死因,出血类型以蛛网膜下腔出血最为常见,有22例(61.11%)。脑血管畸形部位和形态复杂多变,常规检查方法不能满足鉴定的需要。结论脑血管畸形猝死的鉴定百分之百准确比较困难,熟悉其法医病理学特点,掌握多种检查方法,才能做出客观、全面、准确的鉴定结论。

The study of forensic pathology of cerebrovascular malformation causing sudden death

Objective To study forensic pathology characteristics of cerebrovascular malformation causing sudden death and examination methods. Methods We reviewed records of 36 patients with cerebrovascular malformations causing sudden unexpected death discharged from West China Forensic Expertise Center in Sichuan from 1997 to 2006.Results The dominating group (25 cases, 69.44%) is male aged from 10 to 49 years. 18 cases (50%) fell ill at inducing causes, and 18 cases (50%) died in one hour. Arteriovenous malformation (33 cases, 91.67%) was the most important in cerebrovascular malformations. The most locations(24 cases, 66.67%) were the base of the brain, pons and cerebellum. Hemorrhage was the direct cause of death, and subarachnoid hemorrhage was the most common type of brain hemorrhage (22 cases, 61.11%). The location and morphous of cerebrovascular malformations are varied, and routine examinations can't meet the expertise. Conclusion Identification of cerebrovascular malformation causing sudden death is very difficult. Examiner must know pathology characteristics of cerebrovascular malformation well and many examination methods are needed.