Traumatic ponto-medullary tear: a case report.

The aim of this report is to demonstrate the correlation between an extremely short time acting but strong force leading to incomplete rupture of the ponto-medullary junction (PMJ) accompanied by rupture of the basilar artery. Potential mechanisms involved in a combined hyperextension and axial torsion of the head followed by characteristic lesions at the PMJ are discussed. A 33-year-old male suffered a blunt head injury following a blow to the head, i.e. a head-butt. Resuscitation was performed for 45 min without success. At post mortem, there was a superficial periorbital haematoma on the right and a deep soft tissue bruise in the right fronto-parieto-temporal area, but no evidence of skull or dens axis fracture. A deep tear at the ponto-medullary junction was identified with rupture of the basilar artery, whereas at the tip of the tear, i.e. the floor of the IVth ventricle, only a thin tissue layer of about 2 mm remained intact. In contrast to the severity of these lesions, only mild subarachnoid hemorrhage was observed, but the ventricular system was filled with blood clot resulting from the retrograde flow of subarachnoid hemorrhage.