The forensic medical determination of the time of occurrence of subdural hemorrhages in the acute period of fatal craniocerebral trauma]

Presents the results of spectrophotometric and histologic examinations of subdural bleedings, meninges and brain matter in the acute period of a lethal craniocerebral injury. Discusses the possible use of a complex of histologic and biochemical studies in determination of the period elapsed since the injury.     

Fatal acute intracranial injury, subdural hematoma, and retinal hemorrhages caused by stairway fall

We describe an infant with an acute subdural hematoma, a fatal head injury, and severe hemorrhagic retinopathy caused by a stairway fall. His cerebral and ocular findings are considered diagnostic of abusive head trauma by many authors. Our literature search of serious injuries or fatalities from stairway or low-height falls involving young children yielded 19 articles of primary data. These articles are discrepant, making the classification of a young child's death following a reported short fall problematic. This case report contradicts the prevalent belief of many physicians dealing with suspected child abuse that low-height falls by young children are without exception benign occurrences and cannot cause fatal intracranial injuries and severe retinal hemorrhages. The irreparable harm to a caregiver facing an erroneous allegation of child abuse requires physicians to thoroughly investigate and correctly classify pediatric accidental head injuries.     

The forensic medical assessment of the micromorphology of brain stem hemorrhages in craniocerebral trauma

Microscopic features of primary and secondary hemorrhages in the stem portion of the brain in craniocerebral injuries are described. Criteria of differential diagnosis between primary and secondary hemorrhages in the stem in subjects dead during 24 h after isolated and combined craniocerebral injuries are defined. The forensic medical significance of differential diagnosis of hemorrhages in the stem for the solution of many expert problems is evaluated.     

Morphometric diagnostics of the age of encapsulated subdural hematomas

The present morphometric investigation was carried out using dura matter preparations, capsules, and contents of 94 encapsulated subdural hematomas obtained from the corpses of subjects with a non-penetrating craniocerebral injury and the duration of the post-traumatic period ranging from 8 days to 2.5 years. The correlation analysis confirmed the necessity of differentiation between resorbed and unresorbed encapsulated subdural hematomas. The data obtained were used to construct 5 regression models for the estimation of the age of unresorbed encapsulated subdural hematomas and 1 regression model for the identification of the age of resorbed encapsulated subdural hematomas. The regression models included different combinations of three morphometric characteristics of the hematoma capsule as the independent variables, viz. maximum thickness, relative extent of hemosiderosis, and relative amount of macrophages in the cellular infiltrate. The amount of variability in the age of encapsulated subdural hematomas accounted for by the regression models is 62%. It is concluded that the results of the study can be used in the practical work of forensic medical experts.     

家兔颅脑钝性损伤模型的建立

目的采用撞击器模拟棍棒形成的颅脑损伤,建立颅脑钝性损伤动物模型。方法 26只大白兔分为重度损伤组(10只)、轻度损伤组(10只)和对照组(6只),采用第三军医大学设计的Ⅱ型卧式生物撞击器,撞击参数设置为重度损伤:550k Pa/cm2,轻度损伤:450k Pa/cm2,撞击深度(10mm)。撞击后在相同时间内,观察各组家兔临床症状和体征、解剖学及组织病理学变化,组间进行比较。结果对照组未见明显的病理变化。轻度致伤组除轻度的皮下出血、蛛网膜下腔出血、线性骨折外,未见其它损伤,符合AIS评分轻度损伤标准(≤2分)。重度致伤组有明显的骨折、脑挫裂伤和颅内出血,符合重度损伤标准(≥4分)。轻、重度致伤组都未见明显的皮肤挫裂伤。结论本实验建立的重度和轻度损伤模型差异明显,且符合相关标准,该动物模型可以应用于相关研究。     

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.     

Determination of the age of subdural hematomas from the concentration of hemoglobin

The photocolorimetric method was employed to measure hemoglobin levels in 46 traumatic subdural hematomas of different age. The data thus obtained were used to construct a logarithmic regression model for the determination of the age of subdural hematomas from the concentration of hemoglobin. The model allows to determine injury time points and intervals at any desired level of confidence probability. The fraction of dispersion of hematoma age values attributable to regression was estimated at 41% which accounts for 74.7% of the maximally possible magnitude. Results of the study can be used in practical work of a forensic-medical experts.     

颅脑损伤血浆降钙素基因相关肽含量变化及法医学意义

目的研究颅脑损伤患者血浆中降钙素基因相关肽（CGRP）水平变化,观察其与颅脑损伤之间的关系并探讨其在颅脑损伤中的作用。方法40例脑外伤患者,其中轻中型（GCS评分9～15分）、重型（GCS评分3～8分）各20例。采用酶联免疫法测定患者伤后第1、3、5、7d及25例体检健康的志愿者血浆中CGRP水平。结果颅脑损伤患者与正常对照组比较血浆中CGRP水平明显增高,除轻中度组第7d外,均有显著性差异（P〈0．05）;且重度组在3d内高于轻中度组,有显著性差异（P〈0．05）。结论颅脑损伤者CGRP水平增高,且因病情加重会进一步升高,但随时间的延长有下降趋势。     

Difficulties in forensic medical evaluation of some forms of craniocerebral injury

Conclusions of 41 repeated expert evaluations of craniocerebral injuries within the framework of criminal and civil cases investigation are analyzed. Some aspects of clinical and forensic medical diagnosis of lethal and nonlethal injuries to the head, evaluation of the quality of medical care, and qualification of the severity of harm to health are discussed. Causes of typical expert errors and approaches to their prevention are shown.     

Crystallographic analysis of liquor for diagnosis and life-time evaluation of craniocerebral injury

Liquor specimens were examined by crystallography in 136 patients with craniocerebral injuries of different severity, hospitalized at the neuroinjury department of Kaliningrad Emergency Hospital and in 12 normal subjects in 1997-1998. The crystallograms were evaluated by a sum of signs, as a result of which specific patterns of colony growth in health and craniocerebral injury of different severity were obtained.     

Principles of records and coding causes of death as a result of craniocerebral injury

Discusses modern requirements to coding of death causes in cases of craniocerebral injury in accordance with the 10th revision of International Statistical Classification of Diseases and Health-Related Problems (ICD-10). Offers the ways to fill in medical certificates of death with consideration for the items of ICD-10 and classification of craniocerebral injuries.     

Age-specific peculiarities of manifestations of a craniocerebral injury in children and adolescents with a combined blunt trauma

This study was designed to estimate the frequency of head injuries and selected manifestations of craniocerebral traumas in children and adolescents with a fatal combined blunt trauma. It is included 289 cases of death from a combined blunt trauma (101 original observations and data of 188 archival documents). The victims were categorized into 3 age groups. One group was comprised of cases from 0 to 3 years of life, group 2 included children aged from 4 to 11 years, and group 3 those at the age from 12 to 18 years. The age was shown to significantly influence both the frequency of head injuries and their severity. The maximum values of the two variables were recorded in the youngest age group. The frequency of head injuries and the number of selected manifestations of the craniocerebral trauma decreased with age.     

Factors and circumstances influencing the development of hemorrhages in livor mortis

Petechial hemorrhages or ecchymoses in the skin of the face and/or in eyelids and/or conjunctivae are one important feature in postmortem diagnosis of lethal strangulation. On the other hand, petechial bleedings can occur in various causes of death, especially in cases of neck or thoracic compression, they can occur in acute cardiac failure, as a result of blood or skin diseases or as a postmortem phenomenon. The focus of this investigation (retrospective study of 279 corpses, found initially in a prone position or some other face down position) was to analyse the frequency of postmortem (hypostatic) hemorrhages and factors which may influence their development. Petechial hemorrhages in livor mortis in the skin of the trunk and extremities were found in 110 cases (39%). The frequency ranged from 41% in the side position and 44% in the kneeling position to 50% in the prone position. Increasing intensity of livor mortis resulted in an increasing frequency of hemorrhages, up to 59%. In cases with a body-mass-index (BMI) of more than 26 the frequency of hemorrhages increased up to 64%. In cases without livor mortis when the corpses were found as well as in cases with complete movement of livor mortis after turning the corpses, no hemorrhages were found. If hypostasis was partly or completely fixed, the rate of hemorrhages increased up to 50%, without additional increase in longer postmortem intervals. Obviously postmortem petechiae develop neither very soon nor days after death, but within a period of several hours after death.     

不同年龄组颅脑损伤CT扫描分析

本文对520例不同年龄组的颅脑损伤CT片进行了观察分析，表明青少年损伤原因以高坠多见，损伤类型以颅骨凹陷骨折及硬膜外血肿多见，老年组损伤原因以头部击伤多见，损伤类型以颅骨骨折、硬膜下血肿、脑多发性挫裂伤及脑多发性血肿多见，成年组介于两者之间。     

MRI detects hemorrhages in the muscles of the back in hypothermia

Morphological findings in death due to hypothermia are variable and predominantly unspecific. Goal of this study was to check the usefulness of post-mortem cross-sectional imaging methods in the diagnosis of externally invisible findings in death due to hypothermia. Three consecutive forensic cases that died due to hypothermia were examined using post-mortem multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) prior to autopsy. MSCT excluded traumatic skeletal and fatty tissue injury. Using MRI, it was possible to detect hemorrhages within the muscles of the back in all three cases, a so far unknown finding in death due to hypothermia. MRI also allowed the detection of hemorrhages in the iliopsoas muscles. Wishnewsky spots remained radiologically undetected using the present examination techniques. In conclusion, hemorrhages of the muscles of the back might serve as a new sign of death due to hypothermia; however, additional studies on their specificity are necessary. Post-mortem MRI is considered as a good diagnosing tool for muscular hemorrhages, with a great potential for examination and documentation.     

Biochemical indices in establishment of the time and cause of intracranial hemorrhages

The contents of glucose, glycogen, creatinine and urea were examined in 240 samples of cadaveric blood; the same examinations were made for 240 samples of the myocardium, as well as of muscles of the skeleton and liver in craniocerebral trauma and acutely impaired cerebral circulation. A statistically reliable dependence of the contents of glucose and glycogen on a trauma extent was defined.