Traumatic basal subarachnoid hemorrhages: Autopsy material analysis

The source of haemorrhage in traumatic basal subarachnoid haemorrhage

“…Only one of our cases survived more than one day. This rapid decline in consciousness and quick progression to death are well reported in the literature (3)(4)(5)(9)(10)(11) . However, it has been proposed that other mechanisms, such as disruption of the brainstem or upper cervical spine, may be causal where collapse and death follow rapidly after trauma and that TBSH may merely be a concomitant lesion (6) .…”

“…It has been well documented that TBSH typically occurs in younger intoxicated males who have been involved in an altercation receiving blows to the head, neck, and or face (3,4,(9)(10)(11) . Every case but one (motor vehicle crash) analysed in this study fits this profile.…”

“…vertebral malformations and fractures as a mechanism of rupture and thus may have overlooked intracranial sites (1,2,11) .…”

“…However, it remains a heavily disputed topic due to the fact that the site of vascular injury is difficult to identify (2,(4)(5)(6)(7)(8)(9) . The diverging views that have emerged within the literature can be described as those in favour of an intracranial rupture site such as the intracranial portion of the vertebral artery or vessels of the posterior cerebral circulation (6,(8)(9)(10) and those in favour of an extracranial rupture site (mainly in the vertebral arteries of the proximal cervical spine) (1)(2)(3)(4)11) . It has even been postulated that vascular injury and haemorrhage are not responsible for causing death and death is caused by disruption of brain stem and/or upper cervical spinal cord (6) .…”

“…The sites of rupture include the region through the foramen transversarium, the region between the atlas and axis, between the atlas and the base of the skull, its emergence from the foramen magnum (intracranially) and the vertebrobasilar junction (1,2) . These vulnerabilities have been related to a number of factors ranging from anatomical structure of the vessel wall to its anatomical course as it runs through the foramen transversarium and into the foramen magnum (2,3,9,11) . Currently, the mechanism of rupture is thought to be due to multiple factors, but primarily due to direct impact or movement of the head upon the neck leading to stretching, shearing, or compressive forces on the vessel externally (2-6, 9, 10) .…”