MRI诊断弥漫性轴索损伤36例分析

弥漫性轴索损伤(DAI)是钝性外力作用于头部所致的一种原发性、器质性、闭合性脑损伤,是指以脑深部神经肿胀、断裂为特征的弥漫性脑白质损伤类型[1],在临床法医学鉴定中较常见。在CT尚未应用之前DAI多为尸检病理所诊断,CT的应用对活体的DAI诊断无疑有了一定的进展,但对较小的病灶仍常出现假阴性结果,随着MRI的广泛应用,DAI的临床诊断更加可靠。笔者分析了36例CT未能诊断DAI的被鉴定人的MRI表现,以期为DAI的鉴定提供更为直接的客观依据。1资料与方法1.1资料36例资料选自1998年1月～2004年3月河南省人民政府指定对人身伤害进行鉴定…     

交通事故致弥漫性轴索损伤伤残等级鉴定89例分析

目的研究交通事故致弥漫性轴索损伤（diffuseaxonalinjury，DAI）的患者伤残等级鉴定结果，并探讨DAI对鉴定结果可能产生的影响。方法收集556例本鉴定中心2011年1月-2012年12月受理的交通事故致颅脑损伤案例，其中单纯性脑挫（裂）伤467例，临床诊断为DAI89例。再重新审阅被鉴定人颅脑CT及MRI检查结果，分为单纯DAI组、DAI合并脑挫（裂）伤组、无DAI脑挫（裂）伤组3组颅脑损伤，并对鉴定结果进行比较和统计学分析。结果单纯DAI组（20例）的伤残等级为7．72±1．09，DAI合并脑挫（裂）伤组（69例）的伤残等级为7．78±1．11，无DAI的脑挫（裂）伤组（467例）的伤残等级为8．86±0．66，前两组的伤残等级均高于无DAI的脑挫（裂）伤组（P〈0．05）。结论患有DAI的被鉴定人可能存在更为严重的脑功能损害．鉴定时应注意临床的漏诊和误诊，避免过于依赖CT、MRI等影像学表现。     

道路交通事故致儿童颅脑损伤伤残评定204例分析

目的研究道路交通事故致儿童颅脑损伤的类型、特点、主要并发症及其受伤人员伤残评定的特点。方法对204例车祸致儿童颅脑损伤的伤残评定资料按伤者受伤的不同部位、有无并发症、并发症的类型及伤残程度进行统计分析。结果单纯弥散性原发性脑损伤64例,单纯局灶性原发性脑损伤80例,全面性继发性脑损伤24例,局部性继发性脑损伤36例。主要并发症为外伤性癫疒间14例（6.9%）、外伤性脑梗死9例（4.4%）、外伤性脑积水7例（3.4%）、外伤性精神障碍5例（2.5%）。结论道路交通事故致儿童颅脑损伤,以单纯原发性颅脑损伤多见,容易并发外伤性癫疒间及外伤性脑梗死。对涉及儿童颅脑损伤的伤残评定应适当放宽标准,伤残评定标准应增加专门针对儿童的条款。     

CT、MRI在弥漫性轴索损伤法医学鉴定中应用价值分析

目的探讨CT和MRI检查方法在弥漫性轴索损伤(diffuse axonal injury,DAI)法医学鉴定中的应用价值。方法收集26例CT和MRI影像资料齐全的DAI鉴定资料进行回顾性分析,比较CT和MRI两种方法对DAI病灶检出率的差异,分析DAI病灶检出数量与法医学鉴定结果之间的关系。结果 26例经MRI检出DAI病灶787个,经CT检出DAI病灶32个,MRI对DAI病灶的敏感度显著高于CT(P0.01)具有统计学意义。26例DAI鉴定的伤残等级数值与影像学检查发现的病灶数量之间存在负相关(r=-0.908,P0.01)。结论 MRI检查对DAI病灶的检出率较CT检查具有明显优势,可为DAI诊断提供更为准确的依据,在法医临床学鉴定中具有重要的应用价值。     

118例眶壁骨折的法医学鉴定分析

本文通过对2004年至2012年间的118例眶壁骨折的法医学损伤鉴定资料进行分析,旨在阐述外伤性眶壁骨折的法医学损伤鉴定的观点。1案例资料118例眶壁骨折伤者,男性86例、女性32例;年龄12~68岁。所有伤者均为钝性外力致伤,其中拳脚致伤64例(54.2%),棍棒类致伤46例(39.0%),摔倒致伤3例(2.6%),车辆撞击1例(0.9%),致伤过程不明4例(3.4%)。全部行眶壁CT检查,发现     

118例眶壁骨折的法医学鉴定分析

正本文通过对2004年至2012年间的118例眶壁骨折的法医学损伤鉴定资料进行分析,旨在阐述外伤性眶壁骨折的法医学损伤鉴定的观点。1案例资料118例眶壁骨折伤者,男性86例、女性32例;年龄12~68岁。所有伤者均为钝性外力致伤,其中拳脚致伤64例(54.2%),棍棒类致伤46例(39.0%),摔倒致伤3例(2.6%),车辆撞击1例(0.9%),致伤过程不明4例(3.4%)。全部行眶壁CT检查,发现     

弥漫性轴索损伤

<正>弥漫性轴索损伤(diffuse axonal injury, DAI)是以胼胝体、脑干等脑中线部位的局灶性病变及脑白质广泛性轴索损伤为主、临床以原发昏迷时间长而又缺乏神经定位体征的一组原发性弥散性脑损伤。DAI是在特殊外力机制作用下，导致脑内以神经轴索断裂为损伤特征的病理生理变化，是外伤性脑损伤     

磁共振磁敏感加权成像在脑挫（裂）伤鉴定中的应用

轻度颅脑损伤时,CT及普通MRI检查多数仅能发现头皮挫伤、头皮血肿,较少能发现颅内脑实质性变化（器质性改变）。临床医生常依据伤者的头晕、呕吐等症状,将其诊断为脑震荡,从而造成一些脑挫（裂）伤和脑出血的漏诊。依照2014年1月1日起启用的《人体损伤程度鉴定标准》,外伤致脑挫（裂）伤、脑出血为轻伤一级,而仅有头皮挫伤、血肿则属轻微伤,两者的损伤程度级别差别明显。     

致伤方式、致伤工具的法医学复核鉴定分析12例

致伤物的推断及其所致损伤的致伤方式分析是法医学鉴定的一个难题,它不仅能为侦查提供线索,为审判提供证据,而且当多人作案,一人采用多种致伤物及致伤方式或群体斗殴中使用多种致伤物,致多人受伤或死亡;或者当被害人遭受多种损伤而死亡时,可以从伤者或死者身上的损伤对致伤物、致伤方式进行分析,以确定犯罪嫌疑人,达到直接认定犯罪分子的目的。但由于种种原因,在实际工作中,有时会对致伤物推断及其致伤方式分析产生一定的失误,笔者收集１２例对致伤工具及致伤方式进行复核鉴定的案例（由本省市公检法及院校法医所组成的法医技术…     

6例外伤性大脑半球间硬膜下血肿法医学分析

目的 探究外伤性大脑半球间硬膜下血肿（Traumatic Interhemispheric Subdural Haematoma,TISH的损伤特点、影像学特征及法医学鉴定要点，为法医学检验鉴定工作提供参考。方法 收集实际工作中遇到的6例TISH，对伤者基本信息、致伤方式、临床资料及影像学材料进行整理分析。结果 6例TISH伤者年龄最大75岁，最小27岁，平均年龄58岁；男性4例，女性2例；致伤方式为跌倒2例，交通事故3例，打击伤1例；外力作用部位为枕部3例，前额2例，额顶1例；伤后均表现出不同程度的中枢神经系统功能障碍，3例出现大脑镰综合征；CT影像片均可见大脑镰旁特征性高密度出血影；风险因素包括凝血功能障碍、抗凝治疗、酗酒、脑血管瘤、血管畸形等自发出血原因。结论 对TISH伤者进行鉴识时，应结合临床资料、致伤方式、外力作用部位、影像学资料等结果综合分析成伤机制，充分考虑风险因素在损伤鉴定中的参与程度。     

磁敏感加权成像在出血性弥散性轴索损伤鉴定中的应用

目的探讨磁敏感加权成像(susceptibility weighted imaging,SWI)在出血性弥散性轴索损伤(diffuse axonal injury,DAI)法医学鉴定中的应用价值。方法对20例DAI的法医学鉴定资料进行回顾性分析,对其T1WI、T2WI、扩散加权成像(diffusion weighted imaging,DWI)、液体衰减反转恢复(fluid attenuated inversion recovery,FLAIR)、磁敏感加权成像(susceptibility weighted imaging,SWI)序列影像资料进行统计分析。结果 DAI出血灶多位于脑组织表浅区,SWI对出血性DAI的检出率最高,与其他序列成像之间的差异有统计学意义(P0.05)。结论 SWI在DAI法医学鉴定中具有重要的意义。     

Application of diffusion tensor imaging and 1H-magnetic resonance spectroscopy in diagnosis of traumatic brain injury

Mild traumatic brain injury (mTBI) is a common type of brain disorders among young adults. The dysfunction of the brain is often exacerbated due to diffuse axonal injury (DAI) which based on the injury of white matter fibers and axons. Since mild and moderate brain injury or DAI are diffuse and subtle, conventional CT and MRI are difficult to make a positive diagnosis. Recent clinical study indicated that functional magnetic resonance imaging has a high detection rate in the diagnosis of acute mild and moderate brain injury, especially the diffusion tensor imaging (DTI) and 1H-magnetic resonance spectroscopy (1H-MRS). This paper has reviewed the principles and characteristics of DTI and 1H-MRS, and recent research in the clinical and animal experiments on brain injury.     

大鼠弥漫性轴索损伤后NGF表达

目的研究大鼠弥漫性轴索损伤后神经生长因子（NGF）表达的时间变化规律及意义。方法采用SD雄性大鼠复制弥漫性轴索损伤（DAI）模型,分别于伤后1、3、6、12、24、48h和3、7d取脑组织,应用免疫组织化学法对DAI后不同时间段大脑皮层、丘脑、小脑和海马部位NGF的表达变化进行观察并与正常组、假手术组对照。结果正常及假手术组大鼠大脑皮层、丘脑、小脑、海马均有少量NGF的表达。打击后1hNGF表达增强,12h达高峰,3d开始下降,7d降至正常。结论NGF参与弥漫性轴索损伤后的修复：NGF的时序性变化有望成为法医学脑损伤时间推断的客观指标。     

Preliminary Study on Diffuse Axonal Injury by Fourier Transform Infrared Spectroscopy Histopathology Imaging

The objective of this study was to evaluate the application of Fourier transform infrared (FTIR) spectroscopy for detecting diffuse axonal injury (DAI) in a mouse model. Brain tissues from DAI mouse model were prepared with H&E, silver, and β‐amyloid precursor protein (β–APP) immunohistochemistry stains and were also studied with FTIR. The infrared spectrum images showed high absorption of amide II in the subcortical white matter of the experimental mouse brain, while there was no obvious expression of amide II in the control mouse brain. The areas with high absorption of amide II were in the same distribution as the DAI region confirmed by the silver and β‐APP studies. The result suggests that high absorption of amide II correlates with axonal injury. The use of FTIR imaging allows the biochemical changes associated with DAI pathologies to be detected in the tissues, thus providing an important adjunct method to the current conventional pathological diagnostic techniques.     

Modification of the Marmarou and Foda model of diffuse axonal injury (DAI) improves percentage survival of rats at 24 h and increases the amount of DAI identified

More than two decades ago, Marmarou published a valid model for producing diffuse axonal injury (DAI) in rats. Since then, both mild and severe injuries have been obtained by researchers using the original method and a weight of 450 g. However, the diffuse brain injuries produced in rats were only similar to those seen in humans when the rats sustained severe brain injuries. In these cases, rat mortality in the original article was around 50%, and the cause of death was prolonged apnea post-impact. Rat survival after impact is critical for studying the progression of DAI. In order to explain the cause of death in human victims with cranial trauma who do not show gross brain injury, testing for the presence of DAI is essential. Thus, in order to minimize local and cervical injuries to increase rat survival, attention should be paid to the following aspects: a wider head protector disc should be used, the head of the rat should be elevated at the time of impact, and the foam bed should be soft enough to allow the movement caused by acceleration. With our modified method, rat survival increased by 30% compared to the original model (80% versus 50%). Moreover, 85.7% of rats demonstrated DAI after 24 h of survival. With these modifications, injuries appear in the same locations as in humans; thus, the method is suitable for the study of traumatic DAI in humans.     

Diffuse axonal injury by assault

A case of diffuse axonal injury (DAI) by assault is reported. The majority of DAI cases documented have been due to traffic accidents and some due to falls from height. DAI is caused by angular or rotational acceleration of the victim's head. The condition is common and is the second most important head injury after subdural hematoma with regard to death. Its clinical picture is characterized by immediate and prolonged coma or demented state. Because of the subtle nature of histological changes in DAI, awareness and intentional search for the lesion is essential. The triad of DAI is as follows: focal lesions (hemorrhages and/or lacerations) in the corpus callosum and brain stem, and microscopic demonstration of axonal damage--retraction balls. The concept of DAI will elucidate and enhance the understanding of many head trauma cases.     

道路交通事故颅脑损伤的法医学鉴定

目的　研究道路交通事故中颅脑损伤的类型、特点、主要并发症及其受伤人员的伤残评定。方法　 862例道路交通事故颅脑损伤的案例资料 ,按伤者受伤的不同部位、有无并发症、并发症的类型及伤残程度进行统计分析。结果　复合性颅脑损伤 2 76例 ,脑挫伤 192例 ,颅骨骨折 79例 ,颅内出血 91例 ,头皮外伤 2 2 4例 ;主要并发症为脑积水 ( 19例 ,2 2 0 % )、癫痫 ( 16例 ,1 86% )、偏瘫 ( 14例 ,1 62 % )、植物人状态 ( 12例 ,1 3 9% )。结论　道路交通事故中颅脑损伤 ,以头部复合性损伤最多见 ,严重的脑挫伤为最常见的损伤类型 ,并发症的诊断应掌握诊断标准 ,并注意与相关疾病鉴别。     

弥漫性轴索损伤的研究进展

弥漫性轴索损伤（diffuse axonal injury,DAI）以脑白质轴索弥漫性损伤为主要特征,迄今其形成机制尚未完全阐明,不同学科诊断标准迥异,是法医学和神经科学亟待解决的难题。磁共振弥散张量成像（diffusion tensor imaging,DTI）通过检测弥散参数及纤维束成像（fibre tracking,FT）可准确地反映轴索损伤部位及损伤程度,具有广泛的法医学应用前景。本文综述DAI发生机制及诊断方法的研究进展,尤其DTI技术在DAI诊断中的应用。     

大鼠弥散性轴索损伤后β-APP的表达

目的观察大鼠DAI损伤后β-APP表达和Gless神经纤维轴索染色在诊断DAI损伤及判断损伤时间的价值。方法按Marmarou法复制大鼠DAI损伤模型,脑组织常规取材后进行β-APP及Gless氏神经纤维轴索染色观察。结果β-APP及Gless氏染色法在大鼠DAI损伤后0.5h即可见神经轴索断裂、扭曲变形、增粗膨大,12h以后可见到轴索收缩球。二种方法均显示DAI损伤的病理形态学变化,伤后12h明显,1d达到高峰,3d后开始修复,10d后基本恢复正常。β-APP表达强度在实验组不同时间存在着明显的差异,即3h呈明显阳性表达,1d达到高峰,3d后逐渐减弱,10d基本恢复正常。结论β-APP免疫组织化学染色法及Gless氏神经纤维轴索染色法,对DAI的早期诊断具有重要应用价值,并能从病理形态学上反映DAI损伤的时序性。β-APP表达强度变化是推断早期DAI损伤时间的重要参考指标。