Traumatic rupture of the intracranial vertebral artery due to rotational acceleration

Abstract

The reason for blunt forces against the head to rupture the basal brain arteries has been discussed in forensic and trauma research. However, well-documented case reports demonstrating the mechanism of injury, the clinical course and the forensic work up are rare. We present the case of a 40-year-old man, who was assaulted with blunt force to the head resulting in death 34 h later from a longitudinal rupture of the distal left vertebral artery. Computer tomography of the brain and the face demonstrated a basal subarachnoidal haemorrhage, signs of increased intracranial pressure and a fracture of the right orbital bone. Angiography showed a long fusiform dilatation of both intracranial vertebral arteries with an active pseudoaneurysm on the left side. At autopsy signs of a blunt trauma to the head, extensive basal subarachnoidal haemorrhage and a minor subdural haemorrhage were found. Histological examination revealed a transmural longitudinal rupture of the left vertebral artery with vital reaction and no signs of preexisting vascular disease. We discuss the current literature regarding traumatic basal brain artery rupture, important clinical decision making processes as well as pitfalls in the forensic work up. In addition, this singular well-documented case gives new insights in the underlying pathophysiological mechanisms of traumatic basal artery rupture.