Further investigations into the speed of cerebral swelling following blunt cranial trauma

An anesthetized sheep model of traumatic brain injury (TBI) has been developed to assess early changes in intracranial pressure (ICP) following closed head injury. Immediately after TBI, a transient (<10 min) hypertensive response occurred, followed by significant and prolonged systemic hypotension. ICP demonstrated a biphasic response, being seven times baseline values of 8 ± 2 mm Hg 10 min after injury, decreasing to 25 ± 2 mm Hg by 30 min, and then increasing to values exceeding 30 mm Hg by 4 h postinjury. ICP was always significantly higher than baseline values, which combined with hypotension, reduced cerebral perfusion pressure to less than 60% of normal. This early and sustained increase in ICP after craniocerebral trauma acutely alters cerebral perfusion pressure and brain oxygenation and provides a potential pathophysiological explanation for immediate clinical manifestations in humans following significant TBI.     

Blunt force cranial trauma in the Cambodian killing fields

In this paper we present a unique pattern of blunt force cranial trauma that was observed in 10 of a sample of 85 crania from a Cambodian skeletal collection comprised of Khmer Rouge victims. Initial examination of the trauma, which presents as substantial damage to the occipital with fractures extending to the cranial base, suggested the pattern was classifiable as a basilar or ring fracture. However, further investigation, including trauma analysis and historical research, revealed that this fracture type is distinctive from basilar and ring fractures. Historical data indicate that a particular execution method was the likely source of the trauma. Recognition of this trauma pattern is significant because it exemplifies the distinct fracture configuration resulting from an apparently categorical and methodical execution technique. Identification of this fracture type could potentially assist forensic investigators in the recognition of specific methods of murder or execution.     

Histologic evidence of repetitive blunt force abdominal trauma in four pediatric fatalities

In cases of acute fatal child abuse, certain injuries, including cutaneous blunt force trauma, skull fractures, subdural hematomas, intra-abdominal hemorrhage, and retinal hemorrhages are common and well described in the pediatric and forensic literature. These gross findings at autopsy, when taken into consideration with scene investigation and interviews with caregivers, may indicate both a clear manner and cause of death. In such cases, the discovery of additional pathologic changes attributable to older abusive injuries helps support a conclusion of death due to inflicted trauma. We discuss four cases of fatal child abuse in which acute blunt force abdominal trauma was the cause of death. In each of these cases, careful examination with proper sectioning and microscopy of select abdominal tissues revealed that the acute tissue trauma was superimposed on a background of older, healing injury. This older trauma was characterized by classic histologic elements of tissue repair, including fibroblast proliferation, early scar formation, increased vascularity, and hemosiderin-laden macrophages. Iron and trichrome stains were used to confirm the presence of hemosiderin and fibrosis in all four cases, but the recognition of fibroblast proliferation and a reactive vascular pattern was best seen on routine hematoxylin and eosin stains. The gross and microscopic autopsy findings, along with available investigative information, established the diagnosis of chronic physical abuse.     

Discrimination of falls and blows in blunt head trauma: systematic study of the hat brim line rule in relation to skull fractures

In the discrimination of falls from blows in blunt head trauma, the hat brim line rule is one of the most often used criteria. The present study assesses the validity of the hat brim line rule for skull fractures and looks at other possible criteria. All autopsy cases were retrospectively analyzed on a 5-year period. Cases selected consisted of downstairs falls (n = 13), falls from one's own height (n = 23), and homicidal blows (n = 44). Results show that fractures above the hat brim line are more in favor of blows, while fractures in the hat brim line zone are more difficult to distinguish. The majority of fractures were located on the left side for homicidal blows and on the right side for falls. A higher average number of lacerations was revealed for homicidal blows. In conclusion, this study establishes three criteria in favor of blows: (i) localization of a wound above the hat brim line; (ii) left side lateralization; and (iii) a high number of lacerations.     

脑外伤者血浆NSE含量与损伤程度的相关性

目的探讨血浆中神经元特异性烯醇化酶（NSE）含量与创伤性脑损伤程度的关系及法医学意义。方法选取25名健康体检者、34名颅脑损伤患者作为研究对象,根据入院时的GCS评分,将颅脑损伤患者分为轻中型组（GCS≥8分）和重型组（GCS〈8分）。用酶联免疫法对上述研究对象血浆中神经元特异性烯醇化酶含量进行检测。结果在脑外伤24h内,颅脑损伤组血浆中神经元特异性烯醇化酶含量较正常对照组升高,差异有统计学意义（P〈0.05）,重型组与轻中型组相比,差异有统计学意义（P〈0.05）,血清中血浆中神经元特异性烯醇化酶含量越高,患者颅脑损伤程度越严重。结论神经元特异性烯醇化酶可作为早期检测创伤性颅脑损伤的特异性指标,其含量越高,颅脑损伤程度越重。     

The Forensic Implications of Amphetamine Intoxication in Cases of Inflicted Blunt Craniocerebral Trauma

The effects of D‐amphetamine on outcome after blunt craniocerebral trauma are characterized and the potential legal implications discussed. Traumatic brain injury (TBI) was induced under general anesthesia in adult, male Sprague Dawley rats using the impact acceleration model. At 10 min prior to injury, D‐amphetamine (5 mg/kg) or saline vehicle was administered subcutaneously; animals were subsequently assessed over a 7‐day period post‐trauma for motor outcome using a rotarod device. D‐amphetamine treated animals performed significantly better (p < 0.001; ANOVA) than vehicle treated controls on their motor assessment, suggesting that D‐amphetamine exposure prior to injury either is neuroprotective or enhances motor performance. It is possible, therefore, that an individual who has taken amphetamines may function at a better motor level after head trauma than one who has not been exposed to the drug. Future interpretations of the potential effects of amphetamines on TBI should include this possibility.     

An unusual blunt force trauma pattern and mechanism to the cranial vault: Investigation of an atypical infant homicide

This case report presents an unusual fracture pattern in the cranium of a four-month-old infant indicative of child abuse. Upon postmortem examination, the infant presented with numerous bilateral linear cranial fractures running perpendicular to the sagittal suture with depressed and curvilinear fractures apparent on the supra-auricular surfaces of the cranium. Histological evidence indicates multiple traumatic events to the cranium. In addition, the stair-step pattern of a parietal fracture may represent multiple contiguous fractures from repeated loading of the head at different times with variation of the focal points of compressive force. Additionally, the left humerus, left radius, and left ulna have healing metaphyseal fractures, and the left ulna also has an antemortem diaphyseal fracture which resulted in the distal metaphysis being rotated 45 degrees medially. Integration of autopsy, anthropological, and neuropathological reports for this case suggest multiple inflicted injury episodes with a repeated atypical mechanism(s) to the cranial vault of the infant. During investigative interviews, the caretaker admitted to squeezing the infant's head and neck on multiple occasions to quiet the child. This reported abusive mechanism is consistent with the pattern of symmetric cranial fractures and soft tissue injuries indicating asphyxiation. This case report provides forensic investigators with a potential trauma mechanism to explore in cases when a similar pattern of cranial trauma is observed and highlights the need for greater research on fracture propagation and fracture healing in the infant cranium.     

大鼠局灶性脑损伤后calpain1和calpain2的表达

目的探讨大鼠局灶性脑损伤后钙激活中性蛋白酶1和2（calpain1,calpain2）表达规律与损伤时间的相关性。方法健康成年雄性SD大鼠50只,体重200～250g。随机分为10组,每组5只,其中实验组8组,对照组和假手术组各1组。应用免疫组化染色法,检测大鼠脑损伤后不同时程损伤周边区calpain1和calpain2的表达变化。结果对照组及假手术组均有capain1和calpain2表达。伤后15min,损伤周边区calpain1/calpain2阳性染色开始增强,伤后12h达高峰,24h逐渐减弱,5d阳性表达增强达另一高峰,随后逐渐减弱,至15d接近对照组水平。除伤后15d组外,其余实验组与对照组比较,calpain1和calpain2阳性反应物面积百分比及平均光密度值差异均具有统计学意义（P〈0.05）。结论在正常大鼠脑组织中calpain1和calpain2均有表达,局灶性脑损伤后,损伤周边区calpain1和calpain2的表达随时间呈较典型的双峰变化。     

Characterization of Protein Alterations in Damaged Axons in the Brainstem Following Traumatic Brain Injury Using Fourier Transform Infrared Microspectroscopy: A Preliminary Study

Axonal injury contributes greatly to neurological dysfunction following traumatic brain injury (TBI), but current histological diagnostic methods are limited in identifying the pathological profiles of injured axons and unable to provide an objective and accurate quantification. Fourier transform infrared microspectroscopy (FTIRM) has the ability to offer macromolecular bioinformatics of the tissues including biochemical composition and structure by calculating band absorption intensity. In this study, axonal injury in the brainstem of rats with traumatic brain injury at 72 h post‐trauma, which was confirmed with beta‐amyloid precursor protein (β‐APP) immunostaining, was detected with FTIRM technique. The lower intensity of infrared absorbance under the amide I band corresponds strongly to the area of axonal injury, and further analysis of amide I band shows significant differences in protein conformation between injured and normal axons. The findings indicate that using FTIRM technique, the amide I band has potentials to be a infrared spectral marker of axonal injury.     

Patient Profiles of Criminal Behavior in the Context of Traumatic Brain Injury

Traumatic brain injury (TBI) can lead to significant post‐traumatic disturbances in mood and behavior, with the frontal lobes playing a key role in emotional and behavioral regulation. Injury to the frontal lobe can result in disinhibition and aggression which can result in police intervention and/or incarceration. We highlight four adult cases with a history of severe TBI with frontal lobe injuries and the presence of post‐TBI criminal behaviors. There is evidence to support an anatomical basis for aggressive behaviors, yet there are other risk factors to be considered. Behaviors must be investigated thoroughly by obtaining adequate pre‐ and post‐TBI psychiatric and psychosocial histories. By having a comprehensive understanding of aggression while appreciating the complex relationship between TBI, aggression, and premorbid risk factors, clinicians can more adequately treat patients with TBI, with the aim of potentially preventing criminal behaviors and recidivism.     

闭合性颅脑损伤后大鼠BAEP及脑损伤的动态变化

目的观察大鼠闭合性弥漫性颅脑损伤后脑干听觉诱发电位(BAEP)的动态改变及脑组织病理学变化,探讨BAEP在颅脑损伤后评估听觉功能障碍的价值。方法使用自制弹簧式小型生物打击机打击大鼠颅顶部,制造闭合性弥漫性轻型颅脑损伤模型。观察对照组以及伤后15min和1,3,6,12h及1,2,4,7,10,14,21d等时间点大鼠脑组织病理学改变,干/湿法检测脑组织含水量。分别于伤前、伤后各时间点以50Hz刺激率记录大鼠BAEP,对其结果进行比较。结果损伤后15min,BAEP的Ⅰ～Ⅴ、Ⅲ～ⅤIPL即较损伤前延长(P<0.05),至6～12h,Ⅲ、ⅤPL较损伤前延长。损伤后1～2d,Ⅲ、ⅤPL和Ⅰ～Ⅲ、Ⅰ～Ⅴ、Ⅲ～ⅤIPL均较损伤前显著延长(P<0.001),14d后BAEP逐渐恢复正常。伤后15min脑组织含水量开始升高,伤后1d达高峰,持续至4d后逐渐下降,至10d后降至正常水平。结论BAEP可作为闭合性弥漫性轻型颅脑损伤后听觉功能障碍的客观评价指标。     

Machinery‐Related Deaths: Relevance of Workplace Investigation and Antemortem Radiological Data in Reconstructing the Fatality

Abstract: Machinery‐related fatalities are one of the leading causes of traumatic occupational deaths. In our report, we present the case of a 40‐year‐old male who suffered a severe head trauma while working in a cut‐foam industry and died despite an early craniectomy. The radiological reconstruction of the skull based on preoperative computed tomography scans disclosed a large depressed conical fracture of the left parietal bone. The 3D‐reconstruction of the work area, combined with a fit‐matching analysis between the machinery and the depressed skull fracture allowed us to conclude that the head was crushed between the sliding bar of the cutting device and the metallic protuberance on the opposite side. The case underlines the importance of a detailed workplace investigation and of a thorough evaluation of all circumstantial, clinical, radiological, and autopsy data in the reconstruction of machinery‐related fatalities to identify any possible legal responsibilities of the worker and/or the employer.     

大鼠脑损伤后COX-2表达变化的时间规律性研究

目的探讨大鼠脑损伤后环氧合酶2(COX-2)在神经元、神经胶质细胞中表达变化的时间规律性。方法以冲击应力σd为355.09kPa致大鼠脑损伤后,于不同时间段分别应用原位杂交、免疫组化、免疫组化双染色技术检测COX-2mRNA和蛋白的表达强度,用图像分析系统测定阳性反应物平均灰度,进行统计学处理。结果正常对照组COX-2mRNA和蛋白弱表达,伤后15min开始表达呈增强趋势,分别于伤后1,2d,表达达到峰值,平均灰度值分别为126.38±1.36、124.77±3.20,与对照组、邻近上组比较均具有显著性差异(P<0.05),于伤后3,4d,表达达到另一峰值,平均灰度值分别为127.18±1.96、120.14±3.52,并维持高水平表达分别至伤后7,15d,平均灰度值分别为110.03±2.61、111.27±2.83,与对照组比较具有显著性差异(P<0.05)。阳性细胞多为神经元。结论脑损伤后COX-2mRNA及蛋白的表达具有时间规律性,可作为法医学推断脑损伤形成时间的指标。