外伤相关性蛛网膜下腔出血猝死1例

1案件资料1.1案情简介某年某月某日,某男(55岁)在赶海时与人发生争执,死者亲属陈述其右侧头部被人打了一拳,倒在海边一石阶上不省人事,经医院抢救无效死亡。案发后,死者亲属认为是被打致死,而被指方不承认打过死者,双方由此发生争执。1.2尸检情况死者衣着完整,发育正常,营养良好,全身肤色黄规取材切片镜检。显微镜下见:弥漫性蛛网膜下腔出血,以脑底部为著,脑实质未见挫伤、出血。血管破裂口处中膜平滑肌缺失,管壁变薄,血管外膜可见少量急慢性炎细胞浸润。心脏左冠状动脉前降支部分区域粥样硬化。提取死者胃内容物经毒物分析未检见常见毒物。…     

多囊肾致蛛网膜下腔出血死亡1例

多囊肾者可因并发肾功能衰竭、心力衰竭、感染以及颅内出血而猝死,笔者遇一例多囊肾并发蛛网膜下腔出血猝死者,现对其死亡原因分析如下。1案例资料某男,48岁。与同村某妇女(40岁,丈夫长年在外做工)长期保持有不正当的两性关系。2003年8月26日晚到该女家过夜,发生性关系后10余分钟即感全身发热、冒汗、头晕、头痛、支持不住、并迅速发展为意识不清。该女遂将他半扶半拖地架出家门,走出约70m后跌坐在路上,该女独自回家。次日早上,他人发现该男死于路上,死者亲属怀疑是被该女毒害而报案。另据调查,死者平日尚能坚持正常劳动,常感头晕,腰痛,不能…     

酗酒致外伤性蛛网膜下腔出血2例

外伤性蛛网膜下腔出血（ traumatic subarachnoid haemorrage, TSAH）是一种常见的颅脑损伤,在法医病理尸检中尤为常见,可致猝死。国内外学者曾有酗酒后发生 TSAH的报道,大多在酗酒后因琐事被拳击头面部而引起,而本文报道二例主要是酗酒后本人自行倒地而引发 TSAH。作者就此二例尸检报告,结合文献进行死因分析。 1案例 　　案例 1：某男, 42岁,农民。某日中午在家喝了 4瓶花雕酒后骑车上街喝了一碗豆腐花,在返回家途中骑车撞倒在人行道上,不省人事,后被人送到家中,二天后死亡。 　　案例 2：某男, 33岁,工人。生前嗜好喝…     

外伤性基底部蛛网膜下腔出血 3例

近年来,外伤性蛛网膜下腔出血已引起法医工作者的高度重视。作者遇到 3例,现结合文献报道如下。 1 案 例 　　案例 1：某男, 40岁,某日下午 2时许（当日中午饮啤酒一瓶）,因讨工资被他人用石块（约 4kg）抛击（相距约 2m）致左后枕部受伤,突然意识丧失,持续深昏迷,左耳后有一 3cm× 3cm头皮血肿,伤后 7天死亡。死亡当日尸检,尸长 167cm。头左枕部头皮挫伤 6cm× 3cm,呈暗红色,左耳后头皮下出血 5cm× 3cm,颅骨未见骨折。大脑基底部蛛网膜下腔出血（ basal subarachnoid hemorrhage,以下简称为 BSAH）,主要分布在左右颞极…     

轻微外伤致醉酒者蛛网膜下腔出血1例

1案例 1.1简要案情 何某，男，23岁，某年6月7日凌晨2：30许，饮酒后因停车纠纷被人殴打倒地，“120”急救到场后，确认当场死亡。     

少量外伤性蛛网膜下腔出血法医学鉴定分析24例

<正>颅脑损伤导致蛛网膜下腔出血(subarachnoid hemorrhage,SAH)在法医临床检验鉴定中较为常见。按Greere等的CT分级标准,把厚度≤5mm并局限于1～3处的SAH定为少量蛛网膜下腔出血。有报道在外伤性蛛网膜下腔出血(traumatic subarachnoid hemorrhage,TSAH)中少量蛛网膜下腔出血占71.2%,故法医临床检验鉴定应予以足够重视。本文作者结合24例相关案例资料,对其法医学鉴定相     

急性乙醇中毒和外伤在蛛网膜下腔出血致死机制中的作用

目的研究人脑在急性乙醇中毒状态下tPA、MMP-2、MMP-9及AEG-1表达水平与乙醇浓度的关系,分析乙醇与外伤在蛛网膜下腔出血死亡机制中的作用。方法选取15例实际案例,提取脑组织进行组织病理学检查、心血进行乙醇浓度检测,用免疫组织化学法观察人脑干、大脑、小脑tPA、MMP-2、MMP-9及AEG-1表达水平。结果急性乙醇中毒外伤组和急性乙醇中毒组的脑组织肿胀。除小脑tPA外,tPA、MMP-2、MMP-9及AEG-1表达水平在饮酒者较未饮酒者在脑干、大脑、小脑均有升高(P0.05),MMP-2、MMP-9和AEG-1表达水平与心血乙醇浓度存在正相关(P0.05,r0.6)。结论急性乙醇中毒状态下人脑tPA、MMP-2、MMP-9、AEG-1表达较未饮酒者均显著增强,MMP-2、MMP-9及AEG-1表达水平与乙醇浓度存在相关性,乙醇对脑细胞有毒性作用。     

椎动脉瘤破裂致蛛网膜下腔出血猝死1例

1案例某男,29岁,酒后与人争执,突然倒地死亡。尸检:体表未见明显损伤。头皮下、帽状腱膜下以及颈部皮下、肌肉未见出血。颅骨、寰椎、枢椎等未见骨折,寰椎、枢椎未见错位。硬脑膜外、硬脑膜下未见出血。脑底部蛛网膜下腔出血以颈髓、延脑处最著,并从双侧大脑半球外侧裂向大脑顶部延伸。双侧小脑扁桃体疝形成。小心保护脑部血管取出脑组织,仔细检查脑底动脉及分支发现左侧椎动脉颅内段部分管壁轻度增厚、变硬,在福尔马林固定前用止血钳夹闭右侧椎动脉切端,从左侧椎动脉用钝头注射器向脑底动脉注射稀释蓝墨水,见墨水从左侧椎动脉增厚处上方快…     

1例外伤性蛛网膜下腔出血错误鉴定的分析思考

1案例资料1.1简要案情成某,男,21岁。2011年7月26日18时许,因琐事被他人拳击头部。1h后因"外伤后头痛"到医院就诊,查体:左眼外眦部见一约1cm皮肤裂伤,左眼上睑肿胀。当晚CT检查示:右侧天幕缘见宽弧形高密度影,余脑实质未见异常。次日CT检查示:右侧天幕缘未见高密度影,余脑实质未见异常。诊断为蛛网膜下腔出血,眼部软组织撕裂伤。当地公安以"外伤性     

45例死于外伤性蛛网膜下腔出血的案例分析

对上海地区 45例死于外伤性蛛网膜下腔出血的案例进行统计分析 ,指出外伤性蛛网膜下腔出血多发生于男性青壮年民工 ,发生部位以颞、顶、枕叶为主;探讨了酒后意外型、迟发性型及轻微头面部打击型的法医学鉴定。     

Hemorrhagic Retinopathy and Optic Nerve Sheath Hemorrhage Associated With Fatal Subarachnoid Hemorrhage from a Ruptured Intracranial Aneurysm Due to Segmental Fibromuscular Dysplasia

Fibromuscular dysplasia is an idiopathic, nonatheromatous, and noninflammatory arterial disease that most commonly affects the renal and carotid arteries. We report a child with subarachnoid and ocular hemorrhage associated with an aneurysm due to fibromuscular dysplasia. Computed tomography following a witnessed collapse revealed diffuse subarachnoid hemorrhage and severe cerebral edema. An autopsy confirmed the radiographic findings and detected bilateral retinal hemorrhages, optic nerve sheath hemorrhages, and a ruptured saccular aneurysm due to focal fibromuscular dysplasia involving the intracranial right vertebral artery. This case documents a fatal subarachnoid hemorrhage in a child with an intracranial saccular aneurysm caused by fibromuscular dysplasia. The associated retinal hemorrhages are easily detected by postmortem monocular indirect ophthalmoscopy.     

Severe Retinal Hemorrhages with Retinoschisis in Infants are Not Pathognomonic for Abusive Head Trauma

The combination of subdural hemorrhage (SDH), retinal hemorrhage (RH), and encephalopathy, or the presence of severe retinal hemorrhages alone in infants, is often attributed to and has been stated to be pathognomonic for abusive head trauma (AHT) or shaken baby syndrome. These beliefs have been challenged, because the same constellation of findings has been identified in accidental head injuries and natural diseases, and most if not all of the studies that support the concept of diagnostic specificity have serious flaws in their methodology. Presented here are two cases of severe retinal hemorrhages with retinoschisis associated with subdural hemorrhage in a natural disease and with severe cerebral edema in an accidental head injury. These cases challenge the dogma that severe retinal hemorrhages with retinoschisis are pathognomonic for AHT.     

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...     

112例脑弥漫性轴索损伤分析

目的探讨脑弥漫性轴索损伤（diffuse axonal injury,DAI）与脑挫裂伤和原发性脑干损伤的关系。方法分析112例DAI伤者的法医临床学资料和影像学特点,对原发性脑损伤的特征进行比较。结果112例DAI伤者中70.5%为交通事故致伤,多次暴力致伤比较多见（60.7%）,伴脑挫裂伤者80例（71.4%）。CT或MRI发现出血灶者90例。结论DAI多伴有脑皮质挫裂伤和原发性脑损伤,CT或MRI有助于法医学死因分析和伤残程度鉴定。     

Walk and Die: An Unusual Presentation of Head Injury

Abstract:  We report three deaths in young adult males following closed blunt trauma to the head and face where the affected individuals were able to walk away from the incident, before subsequently collapsing and dying a short distance from the site of the assault. In each case, due to the rapidity of the posttrauma collapse, the pathologist was faced with a diagnostic difficulty at autopsy; the external examination revealed multiple injuries to the head and face, but internal examinations showed limited findings with no structural explanation for the death. We discuss possible mechanisms that could account for this scenario, the implications of alcohol consumption with a concussive head injury, and parallels that can be drawn with the so-called "talk and die,""talk and deteriorate," and "second impact syndrome." Finally, the possible role of so-called "postexercise peril" is discussed in relation to these deaths.     

Identifying Fatal Head Injuries on Postmortem Computed Tomography Using Convolutional Neural Network/Deep Learning: A Feasibility Study

Postmortem computed tomography (PMCT) is a relatively recent advancement in forensic pathology practice that has been increasingly used as an ancillary investigation and screening tool. One area of clinical CT imaging that has garnered a lot of research interest recently is the area of “artificial intelligence” (AI), such as in screening and computer-assisted diagnostics. This feasibility study investigated the application of convolutional neural network, a form of deep learning AI, to PMCT head imaging in differentiating fatal head injury from controls. PMCT images of a transverse section of the head at the level of the frontal sinus from 25 cases of fatal head injury were combined with 25 nonhead-injury controls and divided into training and testing datasets. A convolutional neural network was constructed using Keras and was trained against the training data before being assessed against the testing dataset. The results of this study demonstrated an accuracy of between 70% and 92.5%, with difficulties in recognizing subarachnoid hemorrhage and in distinguishing congested vessels and prominent falx from head injury. These results are promising for potential applications as a screening tool or in computer-assisted diagnostics in the future.     

掌骨骨折致伤方式法医学鉴定附27例分析

目的探讨掌骨骨折的形成机制,为掌骨骨折致伤方式的法医学推断提供参考。方法通过对27例致伤方式明确的掌骨骨折案例进行回顾性分析．对不同部位、性质的掌骨骨折结合其致伤方式进行损伤机制分析,并分类统计。结果诸掌骨中以第5掌骨骨折最为常见。就部位而言,又以基底部骨折最为常见,多见于间接暴力传导作用所致;其次为掌骨颈骨折．往往为纵向暴力作用所致。常见于攻击伤、撞击伤;掌骨头骨折常见于握拳时暴力直接打击所致;掌骨体横行或粉碎性骨折为直接暴力作用所致．斜形或螺旋形骨折多为旋转暴力作用所致。结论根据掌骨骨折的部位、性质,通过分析其骨折的形成机制,可以推断其致伤方式,从而为司法鉴定提供有力证据。     

外伤在与疾病共同存在的案件中参与度的评判标准（草案）

在刑事和民事审判中，经常遇到一些损伤与疾病共同存在的案件，审判人员要求法医工作者分析二者在案件中所起的作用。目前国内尚无评定这二者关系的参考标准，为解决这一问题，我们以实际检案、审判实践和医学理论为基础，制定了本标准。根据损伤与疾病的作用大小不同，将外伤参与因果关系的程度划分了若干等级（０％～１００％），就涉及死亡、刑事案件的损伤程度评定（重伤、轻伤、轻微伤）和损害赔偿问题（医疗费、营养费、误工费、伤残者生活补助费、死者丧葬费等）提出了具体的外伤参与度评判方法和量化意见。     

82例肾上腺出血的法医病理学分析

目的 分析肾上腺出血与个体死亡原因、年龄和性别的关系。方法 对82例。肾上腺出血的案例进行统计学分析。结果 （1）肾上腺出血在猝死、感染、外伤和窒息中最多见。（2）肾上腺出血男性多于女性。猝死、外伤和中毒的肾上腺出血多见于青壮年，感染以幼儿多见，窒息主要为胎儿和新生儿。（3）猝死和窒息的肾上腺出血部位主要在髓质，感染以皮质出血为主，外伤在包膜和髓质的出血概率相等。结论 在法医检案过程中，肾上腺出血可以为寻找死因提供线索。