Traumatic Tear of Tela Choroidea Resulting in Fatal Intraventricular Hemorrhage

Abstract

A 39-year-old man was rendered comatose after being struck repeatedly on the head in an altercation. After admission to the hospital, he had computed tomographic scan evidence of diffuse intraventricular and subarachnoid hemorrhage as well as cerebral edema. He shortly thereafter became "brain dead" and life-support systems were discontinued the following day. At autopsy, he had a swollen brain as well as evidence of intraventricular and subarachnoid hemorrhage. No aneurysm or other grossly obvious cause for the hemorrhage was detected. There was, however, a small laceration of the lateral wall of the right lateral ventricle in the region of the caudate nucleus and thalamus, the choroid plexus was detached bilaterally, and the fornices were separated from the corpus callosum. Microscopically, there was further evidence of disruption of the lateral wall of the lateral ventricles, with fragments of ependymal lining mixed in with choroid plexus as well as blood between the fronds of the choroid plexus, and blood dissecting along the wall of the lateral ventricle deep to the ependyma. These findings were felt to be consistent with the recently proposed thesis that tears of the tela choroidea, as part of a so-called inner cerebral trauma, might produce intraventricular and subarachnoid hemorrhage, which, in this case, proved to be fatal.