Carson Henry J
Linn County Medical Examiner's Office, Cedar Rapids, IA 52411, USA.
Am J Forensic Med Pathol. 2010 Dec;31(4):370-2. doi: 10.1097/PAF.0b013e3181d3dbd7.
Severe brain injury is rare after assault to the head with a fist. Our patient was a 39-year-old white male who was punched in a parking lot. The subject fell on his right head. He did not lose consciousness. The subject was taken to the hospital. On admission, his blood alcohol concentration was 229 mg/dL. A CT scan of the head showed no injury. He was admitted to the detoxification unit. He became sober, and was seen ambulating at 3:30 am. By 5:20 am, he was unresponsive. A CT scan of the head showed that an epidural hematoma had developed over the right temporal lobe. The hematoma was drained. The patient did not recover. EEG confirmed no cerebral activity. At autopsy, the brain was removed, showing that the central brain was liquefied. The skull demonstrated a hairline fracture of the right temporal bone, corresponding to the impact with the sidewalk. Our patient differs from the typical victim of head trauma from assault in that severe brain injury or death is typically rare in assault. Alcohol is reported sometimes to have a neuroprotective effect in head injury. The present case illustrates an extreme conclusion of an otherwise-routine head trauma.
用拳头击打头部导致严重脑损伤的情况较为罕见。我们的患者是一名39岁的白人男性，在停车场被人拳击。患者右侧头部着地摔倒，未失去意识，随后被送往医院。入院时，他的血液酒精浓度为229毫克/分升。头部CT扫描未显示损伤，他被收治进戒毒病房。他清醒后，凌晨3点30分还能走动。到凌晨5点20分，他失去了反应。头部CT扫描显示右侧颞叶出现了硬膜外血肿，血肿被引流。但患者未能康复，脑电图证实脑部已无活动。尸检时，取出的大脑显示中央脑区已液化。颅骨显示右侧颞骨有一条细微骨折线，与在人行道上受到的撞击部位相符。我们的患者与典型的因袭击导致头部创伤的受害者不同，因为在袭击中严重脑损伤或死亡通常很少见。据报道，酒精有时在头部损伤中具有神经保护作用。本病例说明了一次原本普通的头部创伤所导致的极端后果。
