Smyk Daniel S, Herath Jayantha C
Department of Laboratory Medicine and Pathology, Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada.
Ontario Forensic Pathology Service, Forensic Services and Coroner's Complex, 25 Morton Shulman Avenue, Toronto, Ontario, M3M 0B1, Canada.
Forensic Sci Med Pathol. 2018 Dec;14(4):536-540. doi: 10.1007/s12024-018-9999-1. Epub 2018 Jun 20.
Vertebral artery laceration/dissection (VALD) resulting in fatal subarachnoid hemorrhage (SAH) is a rare, but well-known phenomenon encountered in the forensic setting. Delayed ruptures are exceptionally rare, and pose several challenges to the forensic pathologist. In this paper we present a case of a 47-year-old male who collapsed suddenly following recent complaints of a headache and a reported seizure. He had a reported history of potential head trauma that occurred several days prior. Attempts at resuscitation were unsuccessful, and an autopsy examination was ordered. Computer tomography (CT), autopsy, histological and ancillary studies were performed. External examination showed mild, healing trauma to the head and upper limbs, and pre-autopsy CT demonstrated a SAH. Examination of the brain showed basally oriented SAH, and there was a laceration of the left vertebral artery. Histological examination demonstrated a delayed rupture, and there was no significant blood vessel abnormality. Molecular testing was negative for collagen vascular disorders. Delayed rupture of the vertebral arteries following head trauma is rare. The presence of remote and/or mild trauma may be difficult to establish at autopsy, and it is important to identify underlying aortopathies. Several autopsy techniques and ancillary studies should be performed in these cases.
椎动脉撕裂/夹层（VALD）导致致命性蛛网膜下腔出血（SAH）是法医领域中一种罕见但广为人知的现象。延迟性破裂极为罕见，给法医病理学家带来了诸多挑战。本文报告一例47岁男性病例，该患者近期诉头痛并曾有癫痫发作史，随后突然晕倒。据报告，他在数天前有潜在头部外伤史。复苏尝试未成功，遂下令进行尸检。进行了计算机断层扫描（CT）、尸检、组织学及辅助检查。外部检查显示头部和上肢有轻度愈合性创伤，尸检前CT显示有SAH。脑部检查显示基底性SAH，左侧椎动脉有一处撕裂。组织学检查显示为延迟性破裂，且无明显血管异常。胶原血管疾病的分子检测为阴性。头部外伤后椎动脉延迟性破裂罕见。尸检时可能难以确定既往和/或轻度创伤的存在，识别潜在的主动脉病变很重要。对于这些病例，应采用多种尸检技术并进行辅助检查。
