Strejc P, Pilin A, Klír P, Vajtr D
Utav soudního lékarství 1. lékarské fakulty UK, Praha.
Soud Lek. 2011 Apr;56(2):18-20.
The hemorrhage as a result of intravital bleeding is considered, from forensic point of view, as important sign of vital reaction of injury. However, in special cases it must be accepted that hemorrhage occurred after the death. The formation of supravital changes is evident, e.g., in organ donors whose blood circulation and pulmonary ventilation is kept after the brain death. The post-mortem origin of hemorrhages can also be seen in donors of eyeballs after enucleation made before the autopsy at Institute of Forensic Medicine and Toxicology. These hemorrhages are manifested after several hours when eyeballs were removed. Moreover, we observed the origin of hemorrhage in orbit which was caused nor by intravital bleeding neither by direct force. Its origin could not be explained nothing but postmortem propagation of the hemorrhage from the fracture of anterior fossa of the scull base. We did not find information about postmortem origin or relocation of hemorrhage of such extent in the literature. In the frame of knowledge about supravital reaction, this finding is of general importance with forensic impact. The documentation from the scene of death allowed correcting the appreciation of the mechanism of injury and traumatic process from the point of view of foreign culpability which should be considered in such case (e.g., a blow to the orbit with following fall under passing subway train).
从法医学角度来看，生前出血导致的出血被视为损伤生命反应的重要标志。然而，在特殊情况下，必须承认出血是在死亡后发生的。超生前变化的形成是明显的，例如，在脑死亡后血液循环和肺通气仍维持的器官捐献者中。在法医学和毒理学研究所进行尸检前摘除眼球的捐献者中，也可以看到死后出血的情况。这些出血在摘除眼球数小时后才显现出来。此外，我们观察到眼眶内出血的起源既不是生前出血也不是直接外力所致。其起源只能解释为颅底前窝骨折导致的死后出血蔓延。我们在文献中未找到关于如此程度的死后出血起源或重新分布的信息。在关于超生前反应的知识框架内，这一发现具有普遍重要性且具有法医学影响。死亡现场的记录有助于从外部罪责的角度纠正对损伤机制和创伤过程的判断，在这种情况下应予以考虑（例如，眼眶受到打击后随后倒在行驶的地铁列车下）。
