Chen Jian-Hua, Ishikawa Takaki, Michiue Tomomi, Maeda Hitoshi
Department of Legal Medicine, Osaka City University Medical School, Asahi-machi 1-4-3, Abeno, Osaka 545-8585, Japan.
Leg Med (Tokyo). 2010 Mar;12(2):97-9. doi: 10.1016/j.legalmed.2009.12.006. Epub 2010 Feb 1.
Traumatic basal subarachnoid hemorrhage (TBSAH) is infrequent but of forensic neuropathological importance because of its high mortality and complex causal mechanisms. The source of the hemorrhage is most frequently identified in the vertebro-basilar arteries but often cannot be identified in these arteries. We present a case of TBSAH possibly originating from hemorrhagic cerebellar contusions due to fist blows to the neck. A 35-year-old woman, who was punched on the right side of the neck, became unconscious about 20 min later and died. Autopsy demonstrated a massive subarachnoid hemorrhage at the base of the brain, with blood clots attached to the right lower surface of the cerebellum. No tear was detected in the vertebro-basilar vessels, but there were hemorrhagic cerebellar contusions beneath the blood clots as a possible source of TBSAH. The site of impact to the neck suggested the cerebellar contusions to be a coup injury due to hard blows.
