Opeskin K, Burke M P
Victorian Institute of Forensic Medicine, Southbank, Australia.
Am J Forensic Med Pathol. 1998 Sep;19(3):206-17. doi: 10.1097/00000433-199809000-00002.
Vertebral artery trauma is not commonly seen by forensic pathologists. The experience of vertebral artery trauma at the Victorian Institute of Forensic Medicine (30 cases) is summarized and reviewed in the light of the literature. Causes of vertebral artery trauma are discussed. In case 1, the history and timing of the injury raise the question as to whether the vertebral artery dissection occurred before the episode of trauma, that is, was spontaneous or resulted from trauma. Moreover, underlying vertebral artery disease was present, raising the question as to how much trauma was needed to cause vertebral artery dissection. In case 2, despite the history of head/neck trauma, a neurosurgeon considered the subarachnoid hemorrhage was spontaneous, due most likely to ruptured saccular aneurysm or arteriovenous malformation. In case 3, the vertebral artery rupture was not diagnosed in the setting of multiple injuries. Case 4 is an example of prolonged survival with delayed onset of symptoms following vertebral artery trauma. Case 5 is an example of the not uncommon scenario of homicidal vertebral artery trauma accounting for basal subarachnoid hemorrhage, rapid collapse and death. Cases 1 and 4 indicate that relatively normal activity may be possible following vertebral artery trauma in some cases (at least for a time). Cases 1 and 4 are also examples of intracranial vertebral artery dissection.
法医病理学家并不常见到椎动脉损伤。结合文献，总结并回顾了维多利亚法医研究所（30例）椎动脉损伤的经验。讨论了椎动脉损伤的原因。在病例1中，损伤的病史和时间引发了一个问题，即椎动脉夹层是否在创伤事件之前就已发生，也就是说，是自发的还是由创伤导致的。此外，存在潜在的椎动脉疾病，这就引出了一个问题，即需要多大程度的创伤才能导致椎动脉夹层。在病例2中，尽管有头/颈部创伤史，但神经外科医生认为蛛网膜下腔出血是自发的，最有可能是由于囊状动脉瘤或动静脉畸形破裂所致。在病例3中，在多处受伤的情况下未诊断出椎动脉破裂。病例4是椎动脉损伤后症状延迟出现且存活时间延长的一个例子。病例5是一个常见的案例，即杀人导致椎动脉损伤引起基底蛛网膜下腔出血、迅速昏迷和死亡。病例1和病例4表明，在某些情况下（至少在一段时间内），椎动脉损伤后可能进行相对正常的活动。病例1和病例4也是颅内椎动脉夹层的例子。
