Traumatic subarachnoid hemorrhage and extracranial vertebral artery injury: a case report and review of the literature

The case is presented of a 19-year-old man who was assaulted and died shortly afterward from a large traumatic basal subarachnoid hemorrhage (TBSAH) that arose from rupture of the left vertebral artery, proximal to the point at which the artery penetrated the dura. The literature regarding TBSAH and vertebral artery rupture is reviewed, and a number of points are highlighted: patients with TBSAH may remain conscious for a period of hours after injury, subcutaneous or muscular bruising may be contralateral to the ruptured vessel, fractures of the transverse processes of the cervical vertebrae and significant pathology of the vertebral artery are not typically associated with TBSAH, and rupture of the vertebral artery may be intracranial, junctional, or extracranial.     

Traumatic basal subarachnoid hemorrhages: autopsy material analysis

Fourteen cases of traumatic basal subarachnoid hemorrhages, examined in the years 1980-1988, were presented. Bleeding was connected with the fracture of the transverse process of the atlas in eleven cases and with atlanto-occipital dislocation in three. The source of hemorrhage--vertebral artery rupture--was determined only four times. In nine cases (63%) atlases showed various developmental malformations (posterior ponticle and foramen arcuale, epitransverse process, incomplete ossification of the transverse process). The results were related to the literature of the subject. Special attention was paid to the mechanism of the rupture of the vertebral arteries in which developmental disorders and pathological conditions may play an important role.     

Traumatic rupture of the basilar artery: report of two cases and review of the literature

Two cases of traumatic rupture of the basilar artery are reported. In the first case, severe basal subarachnoid hemorrhage (SAH) due to a complete transverse tear of the basilar artery was observed in a 53-year-old restrained male driver who was involved in a head-on collision while intoxicated and drowsy. He lost consciousness shortly after the accident and was admitted to hospital in cardiopulmonary arrest. Intensive resuscitative therapies produced cardiac response, but he died 50 minutes after the accident. The ethanol concentration in his blood and urine was 0.35 and 0.55 mg/ml, respectively. In the second case, SAH due to a similar tear of the basilar artery was observed in a 47-year-old man who received several fist blows to the face while intoxicated. He suddenly lost consciousness after the final blow and was admitted to hospital in cardiopulmonary arrest. Intensive resuscitative therapies produced cardiac response, but he died 6 hours after the event. In these cases, the mechanism of the traumatic rupture of the basilar artery is thought to be overstretching due to hyperextension of the head, and intoxication, drowsiness, or both may have interfered with the decedents' ability to protect themselves; thus, the hyperextension of the head may have been rather forceful.     

127例蛛网膜下腔出血案例的法医学研究

目的探讨蛛网膜下腔出血(SAH)对保险公司的直接请求权,从而缓解了患者在请求赔偿方面的特点及法医学鉴定要点。方法通过对华西医科大学法医鉴定中心1983-2001年尸检检出的127例各种原因所致的SAH案例进行回顾性分析。结果各类SAH案例,男性明显多于女性,男女性别比为3:1,高峰年龄为21~40岁。按SAH常见特征可分为外伤性、脑血管畸形、动脉瘤、脑血管粥样硬化、中毒、伴发于心脏疾患、其他等八类。其中,外伤性与脑血管畸形最为多见。外伤性SAH与脑血管畸形出血可见于任何年龄,多见于11~50岁,脑血管粥样硬化出血仅见于50岁以上者,动脉瘤破裂出血者并不多见,见于11~50岁。以SAH为死亡原因者,32例,占25%,多见于脑血管畸形与动脉瘤破裂,出血部位多见于脑底及小脑天幕以下。大多数SAH,出血部位多见于大脑表面,较为局限,出血量较少,非死亡的主要原因。结论多数SAH并非导致死亡的主要原因,SAH死亡者,其死亡性质多属自然死亡。     

127例蛛网膜下腔出血案例的法医学研究

目的探讨蛛网膜下腔出血(SAH)对保险公司的直接请求权，从而缓解了患者在请求赔偿方面的特点及法医学鉴定要点。方法通过对华西医科大学法医鉴定中心1983—2001年尸检检出的127例各种原因所致的SAH案例进行回顾性分析。结果各类SAH案例，男性明显多于女性，男女性别比为3：1，高峰年龄为21～40岁。按SAH常见特征可分为外伤性、脑血管畸形、动脉瘤、脑血管粥样硬化、中毒、伴发于心脏疾患、其他等八类。其中，外伤性与脑血管畸形最为多见。外伤性SAH与脑血管畸形出血可见于任何年龄，多见于11～50岁，脑血管粥样硬化出血仅见于50岁以上者，动脉瘤破裂出血者并不多见，见于11～50岁。以SAH为死亡原因者，32例，占25％，多见于脑血管畸形与动脉瘤破裂，出血部位多见于脑底及小脑天幕以下。大多数SAH，出血部位多见于大脑表面，较为局限，出血量较少，非死亡的主要原因。结论多数SAH并非导致死亡的主要原因，SAH死亡者，其死亡性质多属自然死亡。     

蛛网膜下腔出血的法医学鉴定

蛛网膜下腔出血（subarachnoid hemorrhage,SAH）按其发生原因可分为外伤性SAH与病理性SAH,其中外伤性SAH是头部外伤的常见表现形式,同时也往往是法医学鉴定的难点。本文根据法医学实际鉴定经验并参考国内外相关的文献资料,阐述了SAH的法医学鉴定要点、检查要点和死亡机制,并尝试将外伤性SAH分为脑损伤伴发性、脑底血管破裂性及局灶性SAH 3种类型以便于理解。     

Traumatic venous aneurysm of the popliteal vein with outcome: a case report and review of the literature.

A case of sudden death due to recurrent pulmonary thromboembolism is described. The fatality took place three and a half weeks following blunt trauma to the left popliteal region. The patient died unexpectedly. Autopsy revealed the source of the emboli as a sacciform venous aneurysm of the popliteal vein, an entity seldom described, but important to consider in cases of soft tissue popliteal masses or unexplained pulmonary embolism, especially in otherwise healthy individuals.     

Cerebrovascular malformation causing sudden death. Analysis of three cases and review of the literature

Three unusual cases of sudden death resulting from cerebrovascular malformation (CVM) are presented. CVMs are highly variable in location and morphology, and may be difficult to detect. Two of the patients discussed here had CVMs that involved the circle of Willis directly, and produced rapidly fatal subarachnoid hemorrhage at the base of the brain; both of these subjects were in their late 30s. One had a history of epilepsy; the other had been completely asymptomatic prior to the catastrophic event. The third was an asymptomatic 6 year old with a cerebellar CVM, who survived long enough for inconclusive neurosurgical intervention. In all three cases, the diagnosis was not made prior to autopsy; in one case, the circumstances of death were initially misleading. The relevant literature is reviewed and discussed, with emphasis on differential diagnosis, anatomic examination, and background investigation.     

Aortoesophageal fistula and sudden death. A report of two cases and review of the literature

Two cases of aortoesophageal fistula are presented. The etiology, symptoms, and diagnosis of aortoesophageal fistula are reviewed. Signs and symptoms of gastrointestinal hemorrhage followed by sudden collapse hours to days later should prompt consideration of an aortoesophageal fistula. Accidental ingestion of foreign bodies, particularly by children, is a frequent etiology.     

Dismemberment: a review of the literature and description of 3 cases

The authors describe 3 cases of dismemberment. Numerous methods of hiding a body and thus erasing proof of murder have been devised. Those most frequently described in the literature include: burial of the body in an unusual or impervious place such as a wood, grotto or mountain; charring the body by wrapping it in a tire, for example, to fuel the fire until all traces of the crime have been erased and identification of the victim is difficult; and dropping the weighted-down body in the open sea or in a well in the hope that it will never be found. Dismemberment is in reality a relatively rare method whereby, after killing the victim, the murderer uses a very sharp cutting weapon (a saw, axe, etc.) to sever the limbs and cut the body into small pieces. The operation is generally carried out immediately after the crime, although more rarely a long time may pass between the 2 events.     

Traumatic asphyxial deaths in car crush: Report of 3 autopsy cases

Traumatic asphyxia is a rare syndrome due to compression of thorax, abdomen or both. The diagnosis of traumatic asphyxia is based on typical findings consisting of cervico-facial congestion with swelling, multiple petechial hemorrhages in skin and conjunctiva with a history of traumatic compression. The authors report three cases of traumatic asphyxia in car crash to illustrate few unusual findings along with the typical autopsy findings. All three cases showed the typical findings of traumatic asphyxia. Regarding unusual findings, blisters containing hemorrhagic fluid were observed in two cases over areas subjected to traumatic compression. One case showed the peculiar skin pattern in the form of absent congestion corresponding to the tight-fitting strap of banyan. Subcutaneous emphysema was noted in two cases in presence of intact visceral pleura. These unusual findings could be used as additional markers of traumatic asphyxia in conjunction with characteristic features to support the diagnosis of traumatic asphyxia.     

Sudden, unexpected death due to cardiac fibroma. Report of a case and review of the literature

A case of cardiac fibroma in a 58-year-old woman with a history of atrioventricular block is described. The patient died suddenly at home 6 days following the insertion of a pacemaker. Review of the pertinent literature is presented.     

Harness racing injuries and deaths. Report of a fatal accident and review of 178 cases

A case of a harness racing accident in which the driver died of head injuries is presented. To evaluate the victim's head injury and corresponding helmet damage, a videotape of the race was reviewed and analyzed. Based on calculations of a simplified trajectory analysis and testing of the helmet, it was determined that the helmet design did not provide adequate protection for the victim. The standards for harness helmet design are being re-evaluated by the harness racing industry to ensure the safety of the drivers. A review of 178 harness racing injuries and deaths, current harness helmet research, and recommendations for safer helmets are discussed. A protocol for the forensic investigation of sports-related injuries and/or deaths is also presented to assist medical examiners in fulfilling their roles as practitioners of preventive medicine.     

Sudden unexpected death due to papillary fibroma of the aortic valve. Report of a case and review of the literature

The case of the sudden unexpected death of a 21-year-old man due to embolization of segments of an aortic valve papillary fibroma to the left main and anterior descending coronary artery is presented. The literature regarding cardiac papillary fibroma is reviewed with particular reference to those cases associated with sudden death.     

Automatic rifle injuries: suicide by eight bullets. Report of an unusual case and a literature review

A 25-year-old man committed suicide by shooting himself with eight bullets fired from a military rifle set on automatic. This rifle has two firing modes: an automatic mode and a self-loading, single-shot mode. Using this case as an example, some important aspects of firearm injuries are discussed with special emphasis on those points that are relevant to automatic military rifles and most applicable to forensic pathology practice. Some of the pathologic features of firearm wounds are reviewed and the role of the pathologist is discussed. Lastly, the most important points that help the pathologist to determine the type or nature of a firearm death--that is, whether it is an accident, homicide, or a suicide--are discussed. Classically, the number of the firearm wounds is used to differentiate suicide from homicide. As in the case reported here, however, when an automatic rifle or a military rifle set on automatic is used, the number of wounds is not a reliable indicator of the type of death.     

Sudden unexpected death due to Taxus poisoning. A report of five cases, with review of the literature.

The toxicity of yew (Taxus) has been known since antiquity. However, in the past 31 years, to our knowledge only six cases of Taxus poisoning have been reported in the literature. In the present paper we add five cases. From a forensic point of view, intoxication with Taxus has three important aspects: (i) the clinical presentation, which among other causes should suggest Taxus intoxication; (ii) the fact that the diagnosis may often be easily made by examination of the contents of stomach, duodenum and small bowel and (iii) the widespread availability in the near future of Taxol, an anti-neoplastic drug which is an alkaloid extracted from Taxus. The clinical and autopsy findings are summarized, the diagnostic aspects are discussed and the literature concerning Taxus is reviewed.