脑震荡后综合征伤残评定研究进展

由于症状表现的主观性以及当前客观检查方法所能提供证据的匮乏,加之赔偿伴生的症状伪装和夸大等问题,脑震荡后综合征患者的伤残评定鉴定意见一致性不高.在人体损伤赔偿纠纷中,脑震荡后综合征患者的伤残评定成为法医精神病鉴定的争议点和难题.通过对脑震荡及相关术语变化、脑震荡后综合征的发生率、症状表现及诊断标准、脑震荡后综合征客观评...     

轻度颅脑外伤脑震荡后综合征发生率及相关影响因素分析

轻度颅脑外伤的患者，在司法诉讼中常以持久的脑震荡后综合征（posteoneussional syndrome，PCS）导致精神残疾而要求对方赔偿。当事人主要表现为持久的躯体、认知和行为症状，典型症状包括头痛、记忆力和注意力下降、眩晕、焦虑、失眠、抑郁、易激惹、易疲乏及对声光敏感。迄今，有关PCS的诊断仍有赖于当事人主观体验的真实暴露，常规CT／MRI检查技术尚无法直接提供大脑异常的影像学证据。     

脑震荡法医学鉴定中的有关问题探讨

脑震荡是颅脑损伤的一种,也是刑事、民事、行政案件中有关人身损伤的常见诊断。这种损伤的诊断,往往由于缺乏明确的客观依据,给法医工作者对这种损伤诊断的审查、认定带来困难。笔者通过52例脑震荡诊断的法医学鉴定,就脑震荡诊断的审查、取证,以及损伤程度评定等问题谈几点粗浅看法。一、脑震荡临床表现和诊断脑震荡是头部受直接或间接暴力作用后,大脑发生的一过性功能障碍。脑震荡的发病机理并不十分明确,一般认为与脑干网状结构受损、脑干机械性牵拉扭转,外伤时恼脊液在脑室内震动,颅内压力的改变,血管功     

闭合性弥漫性脑损伤早期病理变化的实验研究(Ⅰ)

法医学和临床医学上有许多关于脑损伤问题未得到圆满解释，例如，脑损伤后迅速死亡，影像学检查未发现具有诊断意义的病变，常规病理学检验病变轻微的案例，临床诊断和法医学死因鉴定皆存在极大困难[1-5]。有时，明显的脑损伤并不一定是最危险的，少数案例脑实质溢出可能不死亡，而有的损伤看来是轻微的却可能致死[1－3].一、脑损伤动物模型的建立及实验研究由于闭合性脑损伤，特别是弥漫性轴索损伤（DAI）和脑震荡等形态改变轻微的弥漫性脑损伤的尸检材料很少，因此，建立脑损伤的动物模型已成为进行这方面研究的主要手段[3,4,6]。建立脑…     

脑震荡与脑损伤之间"界"与"度"的法医学立论

观察钝力打击头部后的生理功能和脑病理改变,探讨脑震荡与脑损伤界与度的诊断划分。以震荡钝力打击猫头部建立脑震荡和脑损伤的动物模型,取猫脑进行病理形态学观察,同时观察打击后脑电图、心电图、呼吸、意识障碍等生理功能变化,以脑组织和功能在不同时间内是否存在可复性为依据,发现脑震荡和脑损伤之间存在明显的“界”的标志,在界定下亦可分“度”,以利于法医学损伤程度的鉴定和临床诊断。     

道路交通事故精神伤残评定相关问题

近年来,道路交通事故频繁发生,造成严重的人身伤害。许多颅脑损伤患者伤后常出现明显的行为或认知缺陷,创伤性脑损伤患者精神障碍的患病率明显增高,精神伤残的评定日益增多。但同时,关于精神伤残评定的争议也日益激烈。首先介绍国内外精神伤残的相关概念,然后分析道路交通事故精神伤残评定标准存在的不足和缺陷,重点分析道路交通事故中精神伤残程度的影响因素,并介绍精神伤残评定中的检查方法,最后提出解决精神伤残评定分歧的思路。     

国外期刊有关脑外伤后遗精神障碍文献

综述：创伤性脑损伤的后果探讨［英」／StrattonM．C，etal／／BrainInj1994；8（7）：631本文将从病因学、疾病特点及预后三方面对创伤性脑损伤（TraumaticBrainInjury以下简称TBI）进行讨论，重点是TBI对患者神经心理功能和人际交往的影响。自一国：脑损伤及其历响一、TBI的性质（一）TBI的神经病理学TBI可分为开放性颅脑损伤和闭合性颅脑损伤。开放性颅脑损伤的定位诊断比较容易，脑组织损伤一般集中于外物的进入路径上；闭合性颅脑损伤较开放性颅脑损伤更为常见，脑组织所受损伤一般为挫伤、裂伤，脑损伤往往不仅仅局限于受创…     

轻度创伤性脑损伤脑脊液及血液生物标记物研究进展CSCD

轻度创伤性脑损伤(mild traumatic brain injury,MTBI)被认为是轻度脑损伤导致的短暂意识丧失和精神改变,但有时也会导致持久性、进行性的临床症状。MTBI可引起神经系统结构损伤及相应的体液生物标记物改变,但有关其严重程度及个体易感性与意识障碍持续时间的关联程度研究不足,同时,一次打击后脑损伤程度也缺乏可靠的评估方法。本文综述了与TBI有关的脑脊液及血液生物标记物,探讨这些标记物在MTBI诊断中的应用现状及研究前景,为法医学及临床医学中脑损伤的诊断及评估提供参考依据。     

轻度创伤性脑损伤脑脊液及血液生物标记物研究进展

轻度创伤性脑损伤(mild traumatic brain injury,MTBI)被认为是轻度脑损伤导致的短暂意识丧失和精神改变,但有时也会导致持久性、进行性的临床症状。MTBI可引起神经系统结构损伤及相应的体液生物标记物改变,但有关其严重程度及个体易感性与意识障碍持续时间的关联程度研究不足,同时,一次打击后脑损伤程度也缺乏可靠的评估方法。本文综述了与TBI有关的脑脊液及血液生物标记物,探讨这些标记物在MTBI诊断中的应用现状及研究前景,为法医学及临床医学中脑损伤的诊断及评估提供参考依据。     

实验性大鼠脑震荡后Bcl-2的表达

目的观察实验性大鼠脑震荡后Bcl-2表达的变化规律。方法应用免疫组织化学方法检测大鼠脑震荡后不同时间大脑皮层、脑干和小脑等脑区内Bcl-2表达的变化规律进行研究。结果对照组大鼠未见Bcl-2蛋白的表达。脑震荡组损伤后1h组可在神经细胞内观察到少量Bcl-2蛋白的表达,4d达到高峰,8d和16d,Bcl-2蛋白表达随后逐渐下降。结论Bcl-2的检测可能成为脑震荡的诊断和脑损伤时间推断的一个敏感指标。     

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.     

Mild Traumatic Brain Injury and Postconcussion Syndrome: The New Evidence Base for Diagnosis and Treatment

McCrea’s book makes an important contribution to our understanding of mild traumatic brain injury (MTBI) and post-concussive syndrome (PCS). It offers an excellent review of studies over the past 5–10 years, particularly those in the area of sports medicine/concussion. The author has established a consensus definition of MTBI and best practice in the management and treatment of these patients, while forcing us to rethink the ‘true incidence’ of persistent PCS. There are a host of other conclusions, ideas for future research, and inaccuracies previously published in the literature that are clarified that will be helpful for clinicians working with this challenging patient population. The book is considered a scholarly contribution that most neuroscientists and clinicians who work with MTBI patients will find helpful. One limitation of the book as well as one lingering question that remains unanswered are discussed at the end of the review.     

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.     

Incidental findings in magnetic resonance imaging (MRI) brain research

The use of magnetic resonance imaging (MRI) to investigate brain structure ("structural MRI") and function (so-called "functional MRI") has become increasingly common among neuroscientists, psychologists, and even economists in recent years. Yet, despite this increase in use, relatively little attention has been paid to the issue of incidental findings. The current paper discusses these issues, and anticipates the future of incidental findings in the context of other neuroimaging tools currently being used to investigate the living brain.     

Application of ultrasonography to postmortem examination. Diagnosis of pericardial tamponade

In postmortem examination, it is difficult to diagnose pericardial tamponade in a dead body from the findings of conventional external examination alone. However, ultrasonography is a common diagnostic tool for pericardial tamponade in clinical practice. We studied the postmortem diagnosis of pericardial tamponade at external examination level by applying an ultrasonographic device. The ultrasonographic findings were compared with the conventional autopsy findings. Among 455 cases of forensic autopsy in Hamburg and Tokyo conducted within 5 days after death, we successfully diagnosed 11 cases of pericardial tamponade by ultrasound imaging prior to autopsy, and failed to diagnose pericardial tamponade in only two cases. In addition, 79 cases of external examination conducted at the Tokyo Medicinal Examiner's Office were also examined with ultrasonography, and we diagnosed three cases of pericardial tamponade and five cases of pericardial effusion. The differences in ultrasonographic findings between tamponade and effusion were relatively clear. Although autopsy provides definitive evidence for the cause of death, sometimes autopsy cannot be performed due to some social factors. In such cases, conventional external examination alone cannot establish a cause of death by pericardial tamponade, and application of diagnostic imaging technique will be helpful. While CT and/or MRI may provide more detailed information than ultrasound imaging, these techniques require special equipment, room and specialist, and most of all involves high cost, which is perhaps the most important consideration in the present atmosphere of medical cost containment. On the other hand, the ultrasonographic devices we use are compact, and can be used directly at the scene of death. Postmortem application of ultrasonography may be a valuable adjunct in the work of medical examiners and forensic pathologists.     

Neuroimaging in Mild Traumatic Brain Injury

Neuroimaging in mild traumatic brain injury (mTBI) is reviewed. While computed tomography remains the acute standard for neuroimaging of mTBI, it is only sensitive to gross abnormalities and is typically performed as a measure to rule out more serious and life-threatening injury. Magnetic resonance imaging (MRI), especially at field strength of 3.0 T, is the follow-up neuroimaging standard for assessing potential underlying structural injury to the brain. Several MRI sequences are particularly sensitive to subtle hemorrhagic lesions and signal abnormalities in white matter, sensitive enough to detect pathology when present in mTBI. Clinical correlation of neuropsychological outcome with neuroimaging findings is discussed along with the future potential for functional neuroimaging in evaluating the mTBI patient.     

Image-guided virtual autopsy findings of gunshot victims performed with multi-slice computed tomography and magnetic resonance imaging and subsequent correlation between radiology and autopsy findings

Because the use of radiology in modern forensic medicine has been, until today, mostly restricted to conventional X-rays, which reduces a 3D body to a 2D projection, a detailed 3D documentation of a gunshot's wound ballistic effects was not possible. The aim of our study was to evaluate whether the progress in imaging techniques over the last years has made it possible to establish an observer-independent and reproducible forensic assessment using multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) technologies for the documentation and analysis of gunshot wounds. The bodies of eight gunshot victims were scanned by MSCT and by MRI; the data of these imaging techniques were post-processed on a workstation, interpreted and subsequently correlated with the findings of classical autopsy. With the spiral CT and MRI examinations and the subsequent 2D multi-planar reformation (MPR) and 3D shaded surface display (SSD) reconstruction, the entire gunshot-created complex skull fractures and brain injuries (such as wound channels and deeply-driven bone splinters) could be documented in complete and graphic detail. CT and MRI also documented vital reaction to the gunshot by demonstrating air emboli in the heart and blood vessels and the classic pattern of blood aspiration to the lung. Gunshot residues deposited within and under the skin were visible. In conclusion, we think that the radiological methods of MSCT and MRI have the potential to become a routine "virtual autopsy" tool in the future. Bullets and relevant histological samples from specific sites then might be won in image-guided minimally invasive fashion via percutaneous biopsy. The rapid application of developing radiological methods may lead to new horizons in forensic documentation and intravital as well as postmortem examination.     

体视学技术在医学影像学中的应用及其法医学价值

基于Cavalieri原理的体视学技术经常运用在组织学和病理学的研究中,但是现在,这种技术已经被运用于医学影像学(如CT、MRI、ECT、超声等)的测量。体视学的方法提供了一个非侵入性的、精确的、无偏的、简单的和快速的测量方法。所以该方法在医学影像学的形态计量学的测量中有临床使用价值。而影像资料的定量测量结果则有助于法医学实践。     

Virtopsy: postmortem imaging of the human heart in situ using MSCT and MRI

The rapid further development of computed tomography (CT) and magnetic resonance imaging (MRI) induced the idea to use these techniques for postmortem documentation of forensic findings. Until now, only a few institutes of forensic medicine have acquired experience in postmortem cross-sectional imaging. Protocols, image interpretation and visualization have to be adapted to the postmortem conditions. Especially, postmortem alterations, such as putrefaction and livores, different temperature of the corpse and the loss of the circulation are a challenge for the imaging process and interpretation. Advantages of postmortem imaging are the higher exposure and resolution available in CT when there is no concern for biologic effects of ionizing radiation, and the lack of cardiac motion artifacts during scanning. CT and MRI may become useful tools for postmortem documentation in forensic medicine. In Bern, 80 human corpses underwent postmortem imaging by CT and MRI prior to traditional autopsy until the month of August 2003. Here, we describe the imaging appearance of postmortem alterations--internal livores, putrefaction, postmortem clotting--and distinguish them from the forensic findings of the heart, such as calcification, endocarditis, myocardial infarction, myocardial scarring, injury and other morphological alterations.