18例轻型脑伤并发视神经损伤的法医学鉴定  

Forensic Investigation of Optic Nerve Injury in Mild Brain Trauma in 18 Cases

作　　者：雷星[1] 李生彦[2,3] 赵娟 黄思兴[5] 

机构地区：[1]南充市公安局高坪分局 [2]南充市公安局交警支队 [3]川北医学院法医学系,四川南充637000 [4]北川县公安局,四川北川622750 [5]成都市公安局交通管理局,四川成都610036

出　　处：《川北医学院学报》2010年第6期569-571,共3页Journal of North Sichuan Medical College

摘　　要：目的:探讨轻型颅脑外伤并发视神经损伤的法医学鉴定要点。方法:收集2006年6月-2010年6月受理的鉴定案例中轻型脑伤并发视神经损伤案例进行回顾性分析,所有案例均进行常规眼科检查及相关电生理检查,排除伤前视力下降、伪盲、癔症等,分析受伤机理。结果:18例纳入分析,致伤原因以交通事故最多(14例),单眼受损占15例,双眼3例。头面部着力部位:眶周2例,眉弓2例,额部6例,颞部5例,顶枕3例。损伤当时有11例伴有昏迷。后遗盲目3、4级3眼,低视力12眼,接近正常视力6眼。结论:对于轻型脑伤,由于损伤较轻,其并发视神经损伤及后遗症常难被人所理解;法医鉴定人员应耐心听取伤者的陈述,详细了解受伤和治疗过程,通过全面的眼科检查、影像学及眼电生理检查确诊视神经损伤,明确视力损害程度,排除伪盲、癔症及原有疾病,判明轻型脑伤与视神经损伤的因果关系,客观、准确、公正的作出鉴定结论。Objective：To discuss the forensic identification points of optic nerve injury in mild head trauma.Methods： All cases of optic nerve injury in mild brain trauma collected from June 2006 to June 2010 were analyzed retrospectively.Routine eye examinations and related electrophysiological examinations were carried out in all cases and vision loss before injury,pseudo-blind,hysteria sickness were excluded.Results： 18 cases were included in the analysis,and 14 of them are about the injury resulting from traffic accidents.There are 15 cases of monocular injury and 3 cases of binocular injury.The injury areas on head and face are the following： 2 in orbit,2 in eyebrow,6 in forehead,5 in temple,3 in occipital.Besides,11 cases are accompanied by primary coma.The Sequelae are： blindness in 3 eyes,low vision in 12 eyes,approximate normal eyesight in 6 eyes.Conclusion： Due to light injuries of mild brain trauma,the optic nerve injury and its sequelae are seldom understood and frequently neglected.Therefore,the assessor shall listen attentively to the statements by injured patient,figure out the details about how he is injured and treated,perform an accurate diagnosis of optic nerve damage,identify the degrees of vision loss,exclude pseudo-blindness,hysteria sickness or existing disease,and detect the causality between optic nerve injury and mild brain trauma,through comprehensive eye examination,imaging and electrophysiological examination,so as to generate an objective,accurate and impartial forensic identification.

关 键 词：轻型脑伤 视神经损伤 法医学鉴定 

分 类 号：R749.41[医药卫生—神经病学与精神病学]