[Evaluation of iatrogenic accessory nerve injury in forensic medical practice]. / Az iatrogen accessorius idegsérülés igazságügyi orvosszakértöi megítélése.

The authors give a survey of the clinical and medical-legal characteristics of the accessory nerve injury. In the past two decades the conception of the successfulness of the surgical treatment of the accessory nerve injury became prevailing. About the medical-legal aspects of the iatrogenic injury of the nerve reported in connection of the reconstructive surgery chiefly also departments of neurosurgery, orthopedics and traumatology. In the case of the authors a 70 year old patient suffered 10 years ago a iatrogenic accessory nerve injury. The mild trapezius palsy recovered spontaneously practically with cosmetic disadvantage. In connection with the development of extreme dorso-lumbal scoliosis associated with torsion the trapezius atrophy worsened. Physical therapy was partly successful. But the patient became unfit for manual work. Their observations sustain the data of authors who established that in the case of accessory nerve injury not only the surgical but also conservative treatment is usually successful. In opposite to certain data of the literature the authors establish that the iatrogenic injuries of the accessory nerve may lead to significant lifelong disability. The diagnosis is not always made in time with consequent delay in repair. This may be regarded as an unfavorable issue during medical-legal discussions. The authors recommend in interest to prevent nerve injury in the posterior triangle of the neck to perform operation in special department.

[Evaluation of syncope in medicolegal expertise]. / A syncope megítélése az orvosszakértöi gyakorlatban.

The authors summarise the clinical characteristics of the syncope and neurological signs respectively caused by basilar vertebral artery insufficiency as well as carotid sinus hypersensitivity. Several authors have seen an increased number of patients with neurological symptoms caused by ischaemia in the region of the basilar artery occurring while driving and causing a traffic accident. Carotid sinus hypersensitivity as cause of driving accidents has much less importance. In the case of the authors on a 51 years old man after turning his head to the right a sudden transient loss of consciousness without signs of convulsion developed while driving a car. The attack resulted in a serious traffic accident. Vertebrobasilar insufficiency was presumed as the cause of the signs. Despite the rare incidence of isolated syncope caused by ischaemia in the region of basilar artery, after observation of one and half a year, chiefly supported by the pathological otoneurological findings, the definitive diagnosis could be established. The recurrence of the syncope could not be excluded. An inability to drive was established. The new hungarian legal regulation of 1992, of driving ability emphasises the extraordinary hazards in the traffic posed by processes the sinus of which occur associated with sudden loss of consciousness with great probability, perhaps rarely, but at any time.