Traumatic subarachnoid haemorrhage: a 10-year case study and review

The source of haemorrhage in traumatic basal subarachnoid haemorrhage

“…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) .…”

“…This has been attributed to variable methods of examination. The basal cerebral circulation is often subject to tearing during brain evisceration at autopsy and specialised dissection techniques are required (9,10) . If injury to the head, face, neck, or underlying structures is not visible or suspected, then such techniques necessary for brain and cervical spine retention are not often employed (2) .…”

“…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) .…”

“…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) . However, it has also been proposed that sudden impacts or abrupt movements may lead to a significant increase in intravascular pressure with internal forces further contributing to rupture (4,8,9) . Alcohol, a frequent association with TBSH, is thought to exaggerate these effects on the vessels possibly due to local vascular dilation.…”

“…Alcohol, a frequent association with TBSH, is thought to exaggerate these effects on the vessels possibly due to local vascular dilation. Intoxication may also contribute to injury behaviourally and by decreasing reaction time to blows (4,9,10) .…”