The medicolegal significance of proteoglycans in the tunica media of the vertebral artery.

After an apparently minor blow to the neck, the vertebral artery may rupture, with a fatal outcome. It is medico-legally important to assess whether the structural state of the artery is normal and, if not, whether this abnormality contributed significantly to the individual's death. Histological confirmation of such cases is rare, as are studies of the morphology of this artery. We examined the accumulation of proteoglycans at various sites along this transitional artery in 18 subjects of different ages. There are marked age-related increases in accumulations associated with fragmentation of elastic tissue within the tunica media, with no favoured site for such changes, but with substantially fewer proteoglycans within the intracranial portion of the artery. Focal large accumulations are occasionally seen in isolated segments of arteries, with overall modest counts. We discuss implications of these findings and recommend that multiple sections of artery be examined in cases of vertebral artery rupture in order to avoid misrepresentative assessment of the structural state.