Diagnostics of the cause of aneurism rupture in case of basal subarachnoid hemorrhage: a rare case report
- Authors: Veselkina O.V.1,2, Plis S.S.1, Khutornoy N.V.3, Shishkina L.V.4, Prazdnikov E.N.3, Klevno V.A.1
-
Affiliations:
- Moscow Regional Research and Clinical Institute
- Russian Centre of Forensic Medical Expertise, Ministry of Health of the Russia
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov
- N.N. Burdenko National Scientific and Practical Center for Neurosurgery of the Ministry of Healthcare of the Russian Federation
- Issue: Vol 6, No 4 (2020)
- Pages: 46-53
- Section: CASE REPORTS
- URL: https://journals.rcsi.science/2411-8729/article/view/122424
- DOI: https://doi.org/10.19048/fm346
- ID: 122424
Cite item
Full Text
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.
Full Text
##article.viewOnOriginalSite##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; MoscowSemyon 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, MoscowNikita 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, MoscowLudmila 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, MoscowErik 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, MoscowVladimir 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, MoscowReferences
- Klevno VA, Prazdnikov EN, Dobrovolskiy GF, et al. Basal subarachnoid haemorrhages — etiological and morphological analysis. Russian Journal of Forensic Medicine. 2018;4(2):4–9. (In Russ). doi: 10.19048/2411-8729-2018-4-2-4-9
- Locksley HB. Natural history of subarachnoid hemorrhage, intracranial aneurysms and arteriovenous malformations. Based on 6368 cases in the cooperative study. J Neurosurg. 1966;25(2):219–239. doi: 10.3171/ jns.1966.25.2.0219
- Marek Z. Isolated subarachnoid hemorrhage as a medicolegal problem. Am J Forensic Med Pathol. [981;2(1):19–22. doi: 10.1097/00000433-198103000-00004
- Popov VL. Forensic medical assessment of the role of the injury and pathology in the development of basal subarachnoidal hemorrhage. Forensic Medical Expertise. 2013;56(3):12–17. (In Russ).
- Rosenow J, Das K, Weitzner I, Couldwell WT. Rupture of a large ophthalmic segment saccular aneurysm associated with closed head injury: case report. Neurosurgery. 2000;46(6):1515–1518. doi: 10.1097/00006123-200006000-00041
- Van de Nes JA, Bajanowski T, Trübner K. Fibromuscular dysplasia of the basilar artery: an unusual case with medico-legal implications. Forensic Sci Int. 2007;173(2-3):188–192. doi: 10.1016/j.forsciint.2007.02.016
- Boscolo-Berto R, Macchi V, Porzionato A, et al. Post-traumatic aneurysmal rupture involving the circle of Willis affected by fibromuscular dysplasia. A case report and systematic review. Legal Medicine. 2020;47:101742. doi: 10.1016/ j.legalmed.2020.101742
- Blau A, Richardson JC. Strokes and head injury. Canadian J Neurolog Sci. 1978;5(3):263–266. doi: 10.1017/S031716710002432X
- Knight B. Trauma and ruptured aneurysm. British Med J 1979; 1(6175):1430.
- Avdeev M.I. Zum Problem des kausalen Zusammenhanges in der gerichtsmedizinischen Begutachtung (am Beispiel der basalen Subarachnoidalblutungen). Zeitschrift Fur Rechtsmedizin. Journal of Legal Medicine. 1974;75(1): 61–66. doi: 10.1007/BF02114963
- McCormick WF. The relationship of closed-head trauma to rupture of saccular intracranial aneurysms. Am J Forensic Med Pathol. 1980;1(3):223–226. doi: 10.1097/00000433-198009000-00006
- Plaksin VO. Forensic medical examination in cases of death from basal subarachnoid hemorrhage. Letter from the Bureau of General Forensic Medicine. Moscow; 1995. 12 р. (In Russ).
- Saw AE, McIntosh AS, Kountouris A, et al. Vertebral Artery Dissection in Sport: A Systematic Review. Sports Medicine. 2019;49(4):553–564. doi: 10.1007/s40279-019-01066-0
- Koszyca B, Gilbert JD, Blumbergs PC. Traumatic subarachnoid hemorrhage and extracranial vertebral artery injury: a case report and review of the literature. Am J Forensic Med Pathol. 2003;24(2):114–118. doi: 10.1097/01.PAF.0000065165.81345.7f
- Ong BB, Milne N. Vertebral artery trauma. In: Rutty G.N. (ed.) Essentials of Autopsy Practice. Cham: Springer International Publishing; 2017. Р. 23–41. doi: 10.1007/978-3-319-46997-3_2
- Krauland W. The traumatic subarachnoidal hemorrhage. Zeitschrift Fur Rechtsmedizin. Journal of Legal Medicine. 1981; 87(1-2):1–17.
- Rothschild MA. An interesting case of arterial trauma after craniocerebral injury. Int J Legal Med. 1990;104(1):49–53. doi: 10.1007/BF01816485
- Weiler G, Reinhardt V, Nau HE, Gerhard L. Beitrag zum intracraniellen traumatischen Aneurysma. Zeitschrift für Rechtsmedizin. 1980;85(3):225–233. doi: 10.1007/BF02116324
- Inagawa T, Hirano A. Ruptured intracranial aneurysms: an autopsy study of 133 patients. Surg Neurol. 1990;33(2):117–123. doi: 10.1016/0090-3019(90)90020-P
- Bowen DA. Ruptured berry aneurysms: a clinical, pathological and forensic review. Forensic Sci Int. 1984;26(4):227–234. doi: 10.1016/0379-0738(84)90027-6