Division of Legal Medicine, Department of Community Preventive Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Center of Cause of Death Investigation, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Department of Forensic Medicine, National Defense Medical College, Tokorozawa, Japan.
Leg Med (Tokyo). 2021 Nov;53:101941. doi: 10.1016/j.legalmed.2021.101941. Epub 2021 Jul 12.
Acute subdural hematoma (SDH) occurs following severe head trauma with brain contusion or rupture of bridging veins. Conversely, SDH caused by rupture of a cortical artery without trauma or with minor trauma is also possible. Although over 180 cases of the latter SDH have been reported, they were predominantly diagnosed only during surgery, and therefore, no adequate histological evaluation has been performed. Therefore, essential etiology of this SDH type has remained unclear. In addition, the scarcity of autopsy cases may be attributed to arterial rupture being missed if the microscopic findings are too minimal to detect during autopsy. Here, we describe two autopsy cases of SDH of cortical artery origin. Extravasation on postmortem computed tomography angiography and arterial leakage on macroscopic observation during autopsy facilitated detection of the ruptured artery and allowed detailed histological evaluation of the ruptured artery and adjacent dura mater. The etiology of arterial rupture is briefly described on the basis of histopathological findings in this study and the available literature.
急性硬脑膜下血肿（SDH）发生于严重颅脑创伤伴脑挫裂伤或桥静脉破裂之后。相反，皮质动脉破裂引起的 SDH 也可能没有外伤或仅有轻微外伤。尽管已有超过 180 例此类 SDH 的报道，但它们主要是在手术中诊断出来的，因此没有进行充分的组织学评估。因此，这种 SDH 类型的基本病因仍不清楚。此外，如果尸检时显微镜下的发现太少以至于无法检测到，那么动脉破裂可能会被遗漏，这可能也是尸检病例稀少的原因。在这里，我们描述了两例皮质动脉源性 SDH 的尸检病例。尸检前计算机断层血管造影显示外渗，尸检时肉眼观察到动脉漏出，这有助于发现破裂的动脉，并允许对破裂的动脉和邻近硬脑膜进行详细的组织学评估。根据本研究和现有文献的组织病理学发现，简要描述了动脉破裂的病因。
