Die traumatische subarachnoidale Blutung

Abstract

The Traumatic Subarachnoidal HemorrhageSummary. In general forensic neurotraumatologic experience blunt head traumas can cause a lethal basal subarachnoid hemorrhage. Twenty-seven published cases of traumatic ruptures with either sufficiently described or histologically proven origin from an otherwise "healthy" basal artery system were collected and four new observations were added. In 16 cases detachments and lacerations of arteries in the region of branchings from the Circulus Willisii were described: overstretching ruptures. In eight cases longitudinal ruptures free from branchings were found: bursting ruptures. In the four new cases these 4-5 mm long ruptures we're situated beside the branching of the posterior inferior cerebellar artery. The predominant number of traumas arose from fights under alcoholic influence, which could be classified as minor traumata. Generally only bruises and abrasions in the face were described, furthermore fractures of scull and jaw in three cases and an injury of the cervical vertebral column once. The histologicalproof of the origin of subarachnoidal hemorrhages can be helpful for an exact answer to legal questions. Zusammenfassung" Als Ursache einer t6dlichen basalen subarachnoidalenBlutung (SAB) kommen nach allgemeiner Erfahrung der forensischen Neurotraumatologie auch stumpfe Kopftraumen in Betracht. Aus dem Schrifttum wurden 27 Fglle gesammelt, bei denen die traumatische Ruptur einer ,,gesunden" Schlagaderstrecke hinreichend genau beschrieben und z.T. histologisch gesichert war. Hinzugeffigt wurden vier neue Beobachtungen. Die Rupturen

Fibromuscular dysplasia of the basilar artery: An unusual case with medico-legal implications

“…The cause of death was easy to explain by the traumatic disruption of the basilar artery. Traumatic injury of the basilar artery occurs considerably less frequently than that of the vertebral arteries [19][20][21][22][23]. It has been reported to occur in association with upper cervical trauma [20,[24][25][26] due to blunt impact to the lateral or posterolateral part of the neck [27] or in association with overstretching due to hyperextension and rotation of the neck [23,26].…”

Traumatic Aneurysm Involving the Posterior Communicating Artery

“…The secondary brain injury (edema, increased intracranial pressure, ischemia, brain stem hemorrhages),-documented and assessed both radiologically and by neuropathological examination-agreed "chronologically" with aneurysm rupture occurring during the attack. The studies by Krauland [4,12,28] and other collaborators remain an important guide for diagnostic choices and should be more easily accessible, and also in English. Cases such as this are rare and should be investigated further to clarify the mechanism underlying the development and rupture of the posterior communicating artery.…”

Zur Ph�nomenologie und Morphologie spontaner t�dlicher Hirnaneurysmablutungen

“…Die Zusammenh~inge zwischen fiul3erer Gewalteinwirkung und Aneurysmablutung bereiten wie bereits eingangs erw~ihnt, gutachterlich die gr613ten Schwierigkeiten [5,10,12,17,24,37,40,43,45,47,48,55,56,58,61,67,70,71,79,83,116,123], wobei einerseits die Frage zu prfifen ist, ob ein vorbestehendes Aneurysma aufgrund der Gewalteinwirkung vorzeitig rupturiert ist oder ob eine allein traumatisch bedingte Geffif3ruptur (ohne Aneurysma) vorlag. Auch ein schon lfingere Zeit zurfickliegendes Schfidel-Hirntrauma kann gelegentlich zu einer Geffil3verletzung mit Ausbildung eines ,,Pseudoaneurysmas" ffihren, das erst zu einem sp~iteren Zeitpunkt rupturiert.…”

“…la, b) und erst die Lokalisation und morphologische Untersuchung der Blutungsquelle erlaubt die Differenzierung [55,56,58]. la, b) und erst die Lokalisation und morphologische Untersuchung der Blutungsquelle erlaubt die Differenzierung [55,56,58].…”