Fujiwara S, Yanagida Y, Nishimura A, Ueno Y, Adachi J, Tatsuno Y, Mizoi Y
Department of Legal Medicine, Kobe University School of Medicine, Japan.
Nihon Hoigaku Zasshi. 1993 Oct;47(5):387-97.
A cerebral contusion and DAI (diffuse axonal injury) are practically very important in a medico-legal case of the closed head injury. In this paper, we will report the epitome of the recent advances in the study on the mechanism of them. Coup contusion can be mainly attributed to the skull inbending and/or the skull fracture which develop in the impact region. As to the mechanism of the contrecoup contusion, several theories are reported. During rotational movement of the head, intracerebral shear strains would be produced because of brain lag (Holbourn's rotation theory). Anatomical features of the skull plays an important role (Gurdjian). Relative movement between a brain and a skull induces intracranial cavitation due to pressure gradient (Gross's cavitation theory). Brain is injured by deformation pressure induced by skull deformation and acceleration one done by a movement of the head (Lindenberg). The last one is Courville's transmitted waves of force theory. As to DAI, there is Gennarelli's theory. During a rotational movement of a brain caused by high rate of angular acceleration operating for a long period, intracerebral shear strains occur and injure a brain. As to the brain injuries which include a cerebral contusion and DAI, two theories are reported. Centripetal progression of strains to the core of a brain injuries the brain (Ommaya). Natural frequency of impact determines the nature of resulting injury to the brain (Willinger).
在闭合性颅脑损伤的法医案件中，脑挫裂伤和弥漫性轴索损伤（DAI）实际上非常重要。在本文中，我们将报告它们发病机制研究的最新进展概要。冲击伤主要归因于冲击区域发生的颅骨内陷和/或颅骨骨折。关于对冲伤的发病机制，有几种理论被报道。在头部旋转运动过程中，由于脑滞后（霍尔伯恩旋转理论）会产生脑内剪应变。颅骨的解剖特征起重要作用（古尔吉安）。脑与颅骨之间的相对运动由于压力梯度导致颅内空化（格罗斯空化理论）。脑受到颅骨变形引起的变形压力和头部运动产生的加速度的损伤（林登贝格）。最后一个是库尔维尔的力传递波理论。关于弥漫性轴索损伤，有根纳雷利的理论。在长时间高角加速度导致的脑旋转运动过程中，会发生脑内剪应变并损伤脑。关于包括脑挫裂伤和弥漫性轴索损伤在内的脑损伤，有两种理论被报道。应变向脑核心的向心进展会损伤脑（奥马亚）。冲击的固有频率决定了对脑造成的损伤性质（维林格）。
