Chew Ka Lip, Baber Yeliena, Iles Linda, O'Donnell Christopher
Victorian Institute of Forensic Medicine and Department of Forensic Medicine, Monash University, 57-83 Kavanagh St, Southbank, VIC, 3006, Australia.
Forensic Sci Med Pathol. 2012 Dec;8(4):436-40. doi: 10.1007/s12024-012-9329-y. Epub 2012 Apr 7.
A 25 year old male died suddenly and unexpectedly. Postmortem CT scanning revealed marked raised intracranial pressure with brainstem compression due to subarachnoid, subdural and parenchymal hemorrhage. A hyperdense mass at the termination of the right internal carotid artery was thought to represent an aneurysm. Postmortem, whole body CT angiography failed to fill the aneurysm but did demonstrate multiple central pontine linear enhancing structures in continuity with the mid basilar artery and small foci of contrast leak into the adjacent mid pontine parenchyma. Autopsy confirmed subarachnoid hemorrhage, a thrombosed and ruptured proximal right middle cerebral artery aneurysm and Duret hemorrhages in the mid pons. This finding supports the theory that Duret hemorrhages occur as a result of perforating pontine branch of the basilar arterial rupture but does not exclude the contribution of venous congestion.
一名25岁男性突然意外死亡。尸检CT扫描显示，由于蛛网膜下腔、硬膜下和实质内出血，颅内压显著升高并压迫脑干。右侧颈内动脉末端的高密度肿块被认为是一个动脉瘤。尸检时，全身CT血管造影未能显示动脉瘤，但确实显示了多个与基底动脉中部连续的脑桥中央线性强化结构，以及造影剂渗漏到相邻脑桥中部实质的小病灶。尸检证实有蛛网膜下腔出血、右侧大脑中动脉近端动脉瘤血栓形成并破裂，以及脑桥中部的杜雷氏出血。这一发现支持了杜雷氏出血是由于基底动脉脑桥穿支破裂所致的理论，但不排除静脉淤血的作用。
