Kaiser Ch, Schnabel A, Berkefeld J, Bratzke H
Centre of Legal Medicine, Institute of Forensic Medicine, University of Frankfurt/Main, Germany.
Forensic Sci Int. 2008 Nov 20;182(1-3):e15-7. doi: 10.1016/j.forsciint.2008.10.001. Epub 2008 Nov 13.
The reason for blunt forces against the head to rupture the basal brain arteries has been discussed in forensic and trauma research. However, well-documented case reports demonstrating the mechanism of injury, the clinical course and the forensic work up are rare. We present the case of a 40-year-old man, who was assaulted with blunt force to the head resulting in death 34 h later from a longitudinal rupture of the distal left vertebral artery. Computer tomography of the brain and the face demonstrated a basal subarachnoidal haemorrhage, signs of increased intracranial pressure and a fracture of the right orbital bone. Angiography showed a long fusiform dilatation of both intracranial vertebral arteries with an active pseudoaneurysm on the left side. At autopsy signs of a blunt trauma to the head, extensive basal subarachnoidal haemorrhage and a minor subdural haemorrhage were found. Histological examination revealed a transmural longitudinal rupture of the left vertebral artery with vital reaction and no signs of preexisting vascular disease. We discuss the current literature regarding traumatic basal brain artery rupture, important clinical decision making processes as well as pitfalls in the forensic work up. In addition, this singular well-documented case gives new insights in the underlying pathophysiological mechanisms of traumatic basal artery rupture.
钝性外力作用于头部导致基底脑动脉破裂的原因已在法医和创伤研究中进行了讨论。然而，能充分证明损伤机制、临床病程及法医检查过程的病例报告却很罕见。我们报告一例40岁男性，其头部遭受钝性外力袭击，34小时后因左椎动脉远端纵向破裂死亡。脑部和面部的计算机断层扫描显示基底蛛网膜下腔出血、颅内压升高迹象及右侧眶骨骨折。血管造影显示颅内双侧椎动脉呈长梭形扩张，左侧有一活动性假性动脉瘤。尸检发现头部有钝性创伤迹象、广泛的基底蛛网膜下腔出血及少量硬膜下出血。组织学检查显示左椎动脉有透壁纵向破裂，伴有生命反应，且无既往血管疾病迹象。我们讨论了关于创伤性基底脑动脉破裂的现有文献、重要的临床决策过程以及法医检查中的陷阱。此外，这一记录详实的独特病例为创伤性基底动脉破裂的潜在病理生理机制提供了新的见解。
