外伤3天后迟发型外伤性脑内血肿死亡

Death from Delayed Traumatic Intracerebral Hematoma Three Days after Trauma

迟发型外伤性脑内血肿是指头部外伤后,CT检查未发现异常但再次检查时发现脑内血肿,或于清除颅内血肿一段时间后又发现新血肿。本文介绍了一起迟发型外伤性脑出血的特殊案例,并就发病的机制及相关法医学鉴定进行探讨。某男与他人纠纷时头枕部被撞,头痛呈进行性加重征象,但头部CT检查未见明显异常;3 d后驾车途中突然昏迷,迅速死亡。尸体解剖检见颅内大量血肿形成,病理镜下证实为新鲜出血,排除脑血管畸形和高血压病。因迟发型脑内血肿多发于伤后24 h内,本案例外伤后3 d发生脑血管破裂出血,属迟发型外伤性脑出血的特殊罕见情况。

Usually the delayed traumatic intracerebral hematoma （DTICH） occurs within 24 hours post injury. An extraordinarily rare case is presented here in which a 47-year-old man who died from an intracerebral hemorrhage that occurred three days after he suffered from head injury with his occipital part bumping onto a wall during a dispute. Though getting increased headache after injury, no evidence of abnormality of head was identiifed by computerized tomography （CT） scan the next day. Nevertheless, just three days after the trauma, the man abruptly went into coma when driving and died soon. A large intracranial hematoma was found with pathological anatomy, which was conifrmed under microscope to be caused from fresh bleeding. The incidence of vascular malformation and/or hypertension was ruled out through autopsy. The delayed traumatic intracerebral hematoma was determined to be the cause of death.