Death due to concussion and alcohol

We encountered 5 deaths following blunt trauma to the face and head in which the injuries were predominantly soft tissue in nature with absence of skull fractures, intracranial bleeding, or detectable injury to the brain. All individuals were intoxicated, with blood ethanol levels ranging from 0.22 to 0.33 g/dl. We feel that in these deaths, ethanol augmentation of the effects of concussive brain injury, with resultant posttraumatic apnea, was the mechanism of death.     

Sudden death resulting from epidermoid cyst of the brain

Epidermoid cysts of the brain are rare tumor-like lesions, most often of maldevelopmental origin. They are benign in nature, causing symptoms depending on their localization. Surgical resection leads to excellent results. A case is reported of a 68-year-old-man who died suddenly and unexpectedly. Postmortem examination revealed signs of central dysregulation and a bifrontal epidermoid cyst. To the authors' knowledge, death resulting from epidermoid cyst of the brain has not been reported so far.     

颅脑损伤后精神障碍的相关因素分析

目的 探讨颅脑损伤后精神障碍的相关因素。方法 对42例颅脑损伤伤者的法医学鉴定资料进行回顾性分析,颅脑损伤诊断按照病史资料和颅脑CT/MRI确定;精神障碍按照CCMD-Ⅱ-R、CCMD-3及龚氏修订的韦氏智力量表(WAIS-RC)确定;伤残程度评定根据《道路交通事故受伤人员伤残评定》标准。将所获得的结果,进行统计学分析。结果 精神障碍以脑震荡后综合征居首位(26.2％),其次是遗忘综合征(21.4％)、神经症(16.6％)等。精神障碍以脑伤的低伤残等级多见(Ⅹ级52.4％,Ⅷ级14.3％,Ⅶ级19.0％),但整体差异无显著性意义(P>0.05)。精神病性精神障碍多分布于脑器质性损伤(脑挫裂伤54.8％,脑干损伤16.7％);非精神病性精神障碍多分布于脑功能性损伤,其中脑震荡占21.4％,其差异有高度显著性(P<0.01);智力缺损多见于脑器质性损伤(P<0.05),80.6％分布于脑伤的Ⅹ级、Ⅷ级和Ⅶ级(P<0.01)。结论 颅脑损伤后精神障碍及智力缺损的发生与颅脑损伤的类型、性质有关,与颅脑损伤的严重程度并不平行。     

试论新联结主义的方法论

新联结主义是20世纪80年代早期认知心理学研究中所复兴的另一研究范式。相对于认知心理学的符号加工范式,新联结主义范式把"心理活动像大脑"作为其隐喻基础,这就决定了其在研究过程中必然要对大脑进行模拟研究,采用结构和功能模拟的方法。现代化研究手段不断运用于脑模拟研究,大脑的结构和功能也逐渐为人们所认识,大脑也不再是纯粹的"黑箱"系统,新联结主义就必然要采用灰箱方法。新联结主义把认知主要看成是神经网络相互作用中所突现的整体属性,因而必然会采用还原论与整体主义相融合的研究策略。     

Forensic medical significance of enzymatic products of ethanol oxidation in cadaveric brain

The concentrations of ethanol, acetaldehyde, and the oxidizing enzymes alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (AIDH) were measured in neuronal cytoplasm, limbic cortical capillaries, and cardiovascular center of the medulla oblongata. The measurements were carried out by histochemical methods, gas-liquid chromatography, etc. The results were processed with consideration for the degree and stage of ethanol intoxication in case of death from ethanol poisoning and asphyxia in hanging. Increase of ethanol concentration in the blood was associated with a decrease and then increase in the brain concentrations of ADH and with an increase of AIDH concentration. Enzymatic changes predominated in capillary walls; the minimum shifts were observed in the neuronal cytoplasm of the cerebral limbic cortex, which confirms the neurohumoral nature of detoxication regulation. Lethal ethanol poisoning could occur during any stage of ethanol intoxication. The detected changes in ethanol, acetaldehyde, and metabolizing oxidoreductases in brain tissue can be used for forensic medical diagnosis of ethanol poisoning.     

Determination of cocaine and its metabolites in brain tissue using high-flow solid-phase extraction columns and high-performance liquid chromatography.

A new solid-phase extraction procedure for the determination of cocaine and some of its metabolites in brain tissue, using high-flow co-polymeric sorbents is reported as a substantial improvement on our recently reported procedure. The recovery of cocaine, norcocaine and cocaethylene was excellent as was the reproducibility of the extraction. The use of high-flow sorbents allowed the easy extraction of tissue without the need for a time-consuming lipase digestion, regardless of sample viscosity or physical nature. The use of these solid-phase columns provided many advantages over the more commonly used solvent extraction, including an increase in extraction speed and efficiency, reduced operator time, reduced solvent use and disposal volumes and exceptional extract quality. The procedure was successfully applied to rabbit brains spiked with cocaine, benzoylecgonine, norcocaine and cocaethylene.     

Forensic neuropsychology and the criminal law

This article explores theoretical and empirical issues in the application of clinical neuropsychological evidence to forensic issues in the criminal law. The nature of forensic neuropsychological evaluations is discussed with reference to issues of competency to stand trial, criminal responsibility, and other competencies in the criminal process. Examples of specific disorders relevant to criminal law standards are presented, together with data estimating the prevalence of brain dysfunction in criminal and forensic populations. Research is also reviewed on the role of neuropsychological brain dysfunction in the etiology of violence and criminally relevant behavior. Finally, empirical and ethical issues concerning the applicability and admissibility of forensic neuropsychological data in the criminal context are discussed.     

An unusual death by transcranial stab wound: homicide or suicide?

Penetrating stab wounds of the brain are uncommonly seen in modern times and occur almost exclusively in homicides. We report an unusual death by self-stabbing. A 24-year-old man was found dead at home, the handle of a kitchen knife protruding from his forehead. Data such as the psychiatric history of the victim, the multiplicity and site of wounds, the implement used, the presence of hesitation, and defense wounds were studied to elucidate the manner of death, and the suicidal nature of the event was established after police investigation. Atypical injuries require a careful forensic investigation, and medico-legal aspects of the differentiation between homicide and suicide are discussed in this particular case. A review of the literature revealed few cases of suicidal transcranial stab wounds.     

The forensic-medical diagnosis of lifetime burn trauma by changes in the brain

It is recommended in the paper to define the lifetime or postmortal nature of burn injury that should be made on the basis of differential diagnosis of cause of death. Criteria are suggested, which can be used to distinguish, on the basis of forensic-histological examination of the brain, between mechanical asphyxia and the most widespread types of mechanical trauma typical of murder with arson.     

A middle-aged female serial killer

The case of a 48-year-old woman accused of killing at least 12 elderly women and attempting to kill another one during the last 3 years is presented. Extensive neuropsychological, electrophysiological, and neuropsychiatric testing showed no evidence of a DSM-IV-TR Axis I diagnosis, but a decrease in executive functions and abnormalities in the processing of affective stimuli were found. Behavioral and psychophysiological studies revealed dissociation between knowing how to behave and actually behaving in socially acceptable ways. According to the woman, killing was just her response to "humiliating situations." Two potentially significant conditions in her past history are found: (i) childhood abuse; and (ii) multiple head injuries. It is conjectured that the nature of her crimes, paranoid and personality traits, a probable frontal brain dysfunction, as well as a specific demographic and social context represent unusual factors accounting for her violent behavior.     

Modern aspects of forensic medical diagnostics of the craniocerebral injury

The authors report the results of the investigations of craniocerebral injuries (CCI) including crystallographic studies of brain liquor obtained after the injury and non-traumatic pathological processes. The additional forensic medical criteria for the severity of craniocerebral injuries have been developed and the objective signs of CCI determined to be used for diagnostic purposes in the cases with concomitant diseases and also in the subjects of advanced and declining age. The diagnostic methods for the elucidation of the nature of chronic subdural hematomas and the estimation of the time of their formation have been improved.     

脑震荡后综合征及其客观评定技术的发展

脑震荡后综合征诊断具有很大的争议性。轻度创伤性脑损伤后脑震荡综合征的发病机制,涉及神经损伤和心理社会因素。迄今,已有大量的研究对现有的检查方法或工具(包括精神检查、常规CT和核磁共振、神经心理学测试和神经生化检查)的评定和诊断价值进行了分析。轻度创伤性脑损伤的受损部位主要分布在灰白质交界附近和大脑深部中线结构,由于大脑损伤的弥漫性,常规影像学检查无阳性发现。本文对脑震荡后综合征的流行病学研究、诊断现状及争议、常规诊断技术、新型核磁共振成像技术在脑震荡后综合征和轻度创伤性脑损伤诊断中的应用及展望进行了综述。现代大脑成像技术可无创定量评定大脑损伤,并可能成为脑震荡后综合征诊断及法医学鉴定更敏感和更有前途的评定工具。     

Osler-Weber-Rendu syndrome--pathological manifestations and autopsy considerations

An 18-year-old university student with Osler-Weber-Rendu disease collapsed in the bathroom. Attempted resuscitation was unsuccessful. Her past history included recurrent epistaxes, mucosal telangiectasias, intracranial arteriovenous malformations with previous hemorrhage, a single pulmonary arteriovenous malformation, recent onset of grand mal seizures, and depression. There was a positive paternal family history. At autopsy the pulmonary arteriovenous malformation was confirmed. In addition, within the brain there were widespread areas of gliosis with hemosiderin deposition and small vascular malformations. No other significant abnormalities were detected and toxicological screening revealed only moderately elevated levels of carbemazepine. Death was attributed to epilepsy associated with glial scarring from previous microhemorrhages. The detection of vascular malformations in the lung or brain at autopsy should prompt careful examination of all tissues for similar lesions. Given the possibility of Osler-Weber-Rendu disease in such cases, fibroblast cultures should be undertaken to enable molecular studies to proceed. The heritable nature of this disorder necessitates accuracy of diagnosis at autopsy; once the diagnosis is confirmed family screening should be recommended.     

Ontario Psychological Association Guidelines for Assessment and Treatment in Auto Insurance Claims

The Ontario Psychological Association Guidelines for Assessment and Treatment in Auto Insurance Claims was published on the Ontario Psychological Association website in July, 2010 (Smith, A., and OPA Auto Task Force, 2010, Ontario Psychological Association Guidelines for Assessment and Treatment in Auto Insurance Claims. Ontario Psychological Association, Toronto, Ontario. Retrieved from http://www.psych.on.ca/files/members/OPA_Auto_Practice_Guidelines_July292010_July_30_2010.pdf). Excerpts are reproduced in the journal because of the comprehensive nature of the document. To our knowledge, this is the first time that state or provincial guidelines have included all the major psychological diagnoses in rehabilitation work with motor vehicle accident survivors (chronic pain, post-traumatic stress disorder, traumatic brain injury, depression). Space limitations preclude publishing of the full document, but it should be consulted. The present excerpt focuses on the nature of the psychological injuries and the best practices in treating them, along with cautions for assessment, comorbidities and polytrauma, litigation distress and barriers and complications in recovery.     

The Corpus Callosum and Forensic Issues—An Overview

The corpus callosum is a large central white matter tract that connects the right and left cerebral hemispheres. It permits placental mammals to have a more sophisticated interhemispheric integration of sensory cortices and allows communication between cortical and subcortical neurons. Search of the literature and the pathology archives at The University of Adelaide was undertaken to identify lesions and injuries within the corpus callosum that may have forensic significance. These include developmental/congenital lesions with agenesis/dysgenesis, vascular malformations, and lipomas; inherited syndromes such as neurofibromatosis; and acquired lesions involving trauma, neoplasia, demyelination, vascular conditions, infections, fat embolism, aging/dementia, and the effects of toxins. The finding of lesions within the corpus callosum should initiate careful examination of the adjacent brain and other organ systems for related phenomena as this may shed some light on the nature of the underlying condition, and also help to determine whether there are any forensic implications.     

Correlative Factors for Organic Psychotic Symptoms in Patients Following Traumatic Brain Injury

Objective To investigate the correlative factors for organic psychotic symptoms following trau matic brain injury （TBI）. Methods In the current study, 391 subjects who had undergone forensic iden tification of the organic mental disorders due to TBI were included, both the demographic and posttrau matic information collected. The relevant data were statistically analyzed in those confirmed as organic psychotic syndrome according to Chinese Classification of Mental Disorders 3rd version （CCMD3）. Re suits Fiftytwo subjects （13.3%） were identified as organic psychotic symptoms. The chisquare test showed that the detectable organic psychotic symptoms were associated with the marriage status, damage nature, injury severity and treatment, and the multivariate logistic regression analysis revealed good fitness of treatment and injury severity with the regression model （OR=0.044, 95% CI： 0.0170.114; OR=2.145, 95% CI： 1.201-3.832, respectively）. Conclusion The risks of organic psychotic symptoms following TBI can be involved in the alternative of craniotomy for the cases with trauma and moderate brain injury.     

Pathologic features of childhood pedestrian fatalities

A retrospective analysis of 68 cases of fatal childhood pedestrian accidents in South Australia that occurred over a 20-year period from January 1977 to December 1996 was undertaken. The age range was 12 months to 16 years (average, 7.6 years), with a male to female ratio of 41:27. The most common site of significant injury was the head (91.2%), followed by the abdomen (50%), chest (47.1%), and neck (38.2%). The most frequently encountered significant injury combinations involved the head, chest, and abdomen (14.7%); the head and chest (11.8%); and the head, neck, and abdomen (11.8%). Injuries were severe, consisting of extensive compound and comminuted skull fractures, neck fractures, and massive intraparenchymal brain and internal organ damage with avulsions and fragmentation. Non-life-threatening limb injuries occurred in 88% of cases. A distinct subgroup involved infants and younger children playing in driveways at home who were hit by reversing vehicles. The injuries were often of such a severe nature that death was instantaneous and with no possibility of successful medical intervention. More deaths occurred during the winter than summer months.     

实验性大鼠脑震荡后C—FOS蛋白表达的研究

目的探讨原癌基因c-fos的表达和脑震荡性损伤的关系,同时寻找脑震荡后法医病理学的诊断依据。方法55只实验大鼠随机分为脑震荡组和对照组。用免疫组织化学SABC法观察大鼠脑震荡后脑内C-FOS蛋白表达的变化规律。结果对照组大鼠未见C-FOS蛋白的表达。然而脑震荡组损伤后15min即可在神经细胞观察到C-FOS蛋白的表达,随着损伤后经过时间的延长,表达C-FOS蛋白的细胞数及范围逐渐扩大,损伤后6h表达达高峰,直至损伤后96h均有大量C-FOS蛋白表达。结论 c-fos原癌基因的检测可成为诊断脑震荡和推断脑震荡后经过时间的一项敏感指标。     

Psychopathy and instrumental aggression: Evolutionary, neurobiological, and legal perspectives

In the study of aggression, psychopathy represents a disorder that is of particular interest because it often involves aggression which is premeditated, emotionless, and instrumental in nature; this is especially true for more serious types of offenses. Such instrumental aggression is aimed at achieving a goal (e.g., to obtain resources such as money, or to gain status). Unlike the primarily reactive aggression observed in other disorders, psychopaths appear to engage in aggressive acts for the purpose of benefiting themselves. This is especially interesting in light of arguments that psychopathy may represent an alternative life-history strategy that is evolutionarily adaptive; behaviors such as aggression, risk-taking, manipulation, and promiscuous sexual behavior observed in psychopathy may be means by which psychopaths gain advantage over others. Recent neurobiological research supports the idea that abnormalities in brain regions key to emotion and morality may allow psychopaths to pursue such a strategy—psychopaths may not experience the social emotions such as empathy, guilt, and remorse that typically discourage instrumentally aggressive acts, and may even experience pleasure when committing these acts. Findings from brain imaging studies of psychopaths may have important implications for the law.     

大鼠脑震荡后早期热休克蛋白70表达研究

为寻找脑震荡后法医病理学诊断依据,笔者用单摆式打击装置建立脑震荡模型,分别在打击后立即,15min、2h、4h、8h、24h、48h、72h、96h及120h处死动物取材,用免疫组化PAP法观察大鼠脑震荡后脑内热休克蛋白70表达变化。结果发现脑损伤后15min在暴力作用下局部神经细胞内出现热休克蛋白70表达,之后随损伤后时间的延长,表达热休克蛋白70的细胞数及范围逐渐扩大,损伤后8h表达达高峰,直至损伤120h均有大量热休克蛋白70表达。笔者认为脑神经细胞热休克蛋白70的表达可作为脑组织生前损伤的标志,同时亦可根据其表达变化推测脑损伤经过时间。