Diagnostics of the cause of aneurism rupture in case of basal subarachnoid hemorrhage: a rare case report

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Abstract

Background: Basal subarachnoid hemorrhage (SAH) caused by rupture of intracranial aneurysms usually has non-traumatic etiology. However, head injury shortly before death can start legal case, even if aneurysm was found. In such cases, forensic pathologists have to decide on the cause of the rupture and the role of the injury.

Case presentation: The article presents a rare case from forensic practice: 43 years old male dies after a head blunt trauma. The death was caused by basal SAH, which was caused by a microaneurysm rapture of the left posterior cerebral artery. The autopsy revealed external damages on the face and focal hemorrhages in soft tissues of the head and back. A detailed analysis of the morphological findings, clinical picture and circumstances was performed. The results showed that it was non-traumatic basal SAH. The cause of aneurism rupture was intracranial hypertension increased by vomiting and unusual body position shortly before the death.

Conclusion: Available published articles were studied on the causes of ruptures of pathological cerebral arteries and forensic interpretation in controversial cases. Results suggest that current recommendations should be revised. The hypothesis of the most significant sign indicating unnatural death (localization of the damage in the projection of the brain base) could not be confirmed.

About the authors

Olesya V. Veselkina

Moscow Regional Research and Clinical Institute; Russian Centre of Forensic Medical Expertise, Ministry of Health of the Russia

Author for correspondence.
Email: ves-olesya@yandex.ru
ORCID iD: 0000-0002-9486-5421
SPIN-code: 9188-2988

Assistant of the Department of Forensic Medicine

Russian Federation, 1 bld 61/2, Shchepkina str. Moscow; Moscow

Semyon S. Plis

Moscow Regional Research and Clinical Institute

Email: SSPlis.work@gmail.com
ORCID iD: 0000-0002-0232-0425
SPIN-code: 4347-1925

Assistant of the Department of Forensic Medicine

Russian Federation, Moscow

Nikita V. Khutornoy

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Email: nhutornoy@yandex.ru
ORCID iD: 0000-0003-0068-0643
SPIN-code: 6570-2386

Ph. D. (Med.)

Russian Federation, Moscow

Ludmila V. Shishkina

N.N. Burdenko National Scientific and Practical Center for Neurosurgery of the Ministry of Healthcare of the Russian Federation

Email: lshishkina@nsi.ru
ORCID iD: 0000-0001-7045-7223
SPIN-code: 6341-2050

Ph. D. (Med.)

Russian Federation, Moscow

Erik N. Prazdnikov

Moscow State University of Medicine and Dentistry named after A.I. Evdokimov

Email: Enp1964@gmail.com
ORCID iD: 0000-0002-5817-0702
SPIN-code: 2954-1200

Dr. Sci. (Med.), Prof.

Russian Federation, Moscow

Vladimir A. Klevno

Moscow Regional Research and Clinical Institute

Email: vladimir.klevno@yandex.ru
ORCID iD: 0000-0001-5693-4054
SPIN-code: 2015-6548

Dr. Sci. (Med.), Prof.

Russian Federation, Moscow

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Supplementary files

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1. JATS XML
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2. Fig. 1. a — The unusual position of the body at the scene: kneeling, bending over the edge of the bath and head down; б — Cyanosis and swollen face with traces of blood, signs of vomiting around the mouth

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3. Fig. 2. Localization of the basal subarachnoid hemorrhage in the magna and pontocerebellar cisterns, around the brainstem. View of the vessels of the Willis circle and the vertebrobasilar basin

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4. Fig. 3. Fragment of the posterior cerebral artery wall (stained with hematoxylin and eosin): a — Infundibular protrusion (microaneurysm) of the posterior cerebral artery, ×100; б — Detachment of the internal elastic membrane in the aneurysm neck with gross destructive changes in the muscle layer, ×200

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Copyright (c) 2021 Veselkina O.V., Plis S.S., Khutornoy N.V., Shishkina L.V., Prazdnikov E.N., Klevno V.A.

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

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