Delayed rupture of a vertebral artery laceration: a case report and challenges for the forensic pathologist
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CASE REPORT
Delayed rupture of a vertebral artery laceration: a case report and challenges for the forensic pathologist Daniel S. Smyk 1
&
Jayantha C. Herath 2,3
Accepted: 5 June 2018 # Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract Vertebral artery laceration/dissection (VALD) resulting in fatal subarachnoid hemorrhage (SAH) is a rare, but well-known phenomenon encountered in the forensic setting. Delayed ruptures are exceptionally rare, and pose several challenges to the forensic pathologist. In this paper we present a case of a 47-year-old male who collapsed suddenly following recent complaints of a headache and a reported seizure. He had a reported history of potential head trauma that occurred several days prior. Attempts at resuscitation were unsuccessful, and an autopsy examination was ordered. Computer tomography (CT), autopsy, histological and ancillary studies were performed. External examination showed mild, healing trauma to the head and upper limbs, and preautopsy CT demonstrated a SAH. Examination of the brain showed basally oriented SAH, and there was a laceration of the left vertebral artery. Histological examination demonstrated a delayed rupture, and there was no significant blood vessel abnormality. Molecular testing was negative for collagen vascular disorders. Delayed rupture of the vertebral arteries following head trauma is rare. The presence of remote and/or mild trauma may be difficult to establish at autopsy, and it is important to identify underlying aortopathies. Several autopsy techniques and ancillary studies should be performed in these cases. Keywords Vertebral artery dissection . Vertebral artery laceration . Subarachnoid hemorrhage . Forensic radiology . Computer tomography . Molecular autopsy
Abbreviations CT Computer tomography SAH Subarachnoid hemorrhage VALD Vertebral artery laceration/dissection
* Jayantha C. Herath [email protected] Daniel S. Smyk [email protected] 1
Department of Laboratory Medicine and Pathology, Faculty of Medicine, University of Alberta, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada
2
Ontario Forensic Pathology Service, Forensic Services and Coroner’s Complex, 25 Morton Shulman Avenue, Toronto, Ontario M3M 0B1, Canada
3
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
Introduction Cases of vertebral artery laceration/dissection (VALD) with subsequent subarachnoid hemorrhage (SAH) are a rare, but well-known phenomenon in forensic pathology practice [1–4]. VALD may occur as sequelae from trauma, neck manipulation, and natural disease [5, 6]. It is not uncommon for the trauma to have been relatively mild or trivial, with SAH and death occurring rapidly. SAH due to delayed VALD has been (uncommonly) reported in the clinical setting, and is exceptionally rare in the forensic setting [7]. For the forensic pathologist, the challenges surrounding SAH and VALD encountered at autopsy include the technical challenges of examining vertebral arteries, determination of the etiolo
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