Moriya F, Hashimoto Y
Department of Legal Medicine, Kochi Medical School, Japan.
J Forensic Sci. 1998 Sep;43(5):980-4.
The purpose of this study was to determine how drug findings in intracranial hematomas should be assessed in forensic autopsy cases. Six cases in which intracranial hematomas containing drugs and chemicals were detected were examined in this study. Of the six cases, five were positive for drugs and chemicals that had been self-administered by the victims prior to injury. Post-traumatic time interval from injury to death was in the range 10 to 65 h. In two individuals who were positive for norephedrine or toluene, the concentrations of these substances were much higher in the intracranial hematomas than in heart blood. In an individual who was positive for phenobarbital, its concentration was only a little higher in the intracranial hematoma than in heart blood. In the remaining two cases, substantial quantities of ethanol were detected in the intracranial hematomas, but little ethanol was detected in heart blood. In three cases, some drugs were administered at hospital after the injuries. The time interval from the initial drug administration to death was 19 to 60 h. In two individuals given phenytoin and/or lidocaine intravenously, substantial amounts of these drugs were detected in the intracranial hematomas. In an individual given diazepam intravenously, a substantial quantity of diazepam was detected in heart blood, but not in the intracranial hematoma. Toxicological analysis of intracranial hematomas may be useful not only for determining whether individuals were under the influence of ethanol at the time they were injured, but also for detecting pre-traumatic usage of other drugs and chemicals. However, the medical record should be reviewed thoroughly from a toxicological view point if victims underwent medical treatment prior to death because drugs administered for the purpose of medical treatment can disseminate into preexisting intracranial hematomas, depending on the size of the hematomas.
本研究的目的是确定在法医尸检案例中应如何评估颅内血肿中的药物发现。本研究检查了6例检测到含有药物和化学物质的颅内血肿的案例。在这6例案例中，有5例的药物和化学物质为受害者受伤前自行服用。从受伤到死亡的创伤后时间间隔为10至65小时。在2例去甲麻黄碱或甲苯呈阳性的个体中，这些物质在颅内血肿中的浓度远高于心血中的浓度。在1例苯巴比妥呈阳性的个体中，其在颅内血肿中的浓度仅略高于心血中的浓度。在其余2例案例中，颅内血肿中检测到大量乙醇，但心血中检测到的乙醇很少。在3例案例中，受伤后在医院使用了一些药物。从首次用药到死亡的时间间隔为19至60小时。在2例静脉注射苯妥英和/或利多卡因的个体中，颅内血肿中检测到大量这些药物。在1例静脉注射地西泮的个体中，心血中检测到大量地西泮，但颅内血肿中未检测到。颅内血肿的毒理学分析不仅有助于确定个体在受伤时是否受到乙醇影响，还可用于检测创伤前其他药物和化学物质的使用情况。然而，如果受害者在死亡前接受过治疗，应从毒理学角度全面审查病历，因为用于治疗目的的药物可能会根据血肿大小扩散到先前存在的颅内血肿中。
