18例轻型脑伤并发视神经损伤的法医学鉴定

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。

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

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.