1/9. Death due to positional asphyxia under severe alcoholisation: pathophysiologic and forensic considerations.In contrary to "physical restraint", describing a fixed body position due to external devices, "positional restraint" is defined as an abnormal body position, resulting from accidental fixation under unfortunate circumstances. We report on a remarkable case of positional asphyxia of an alcoholised young man after a fall down a staircase. On external examination, the body showed petechiae of the conjunctivae and oral mucosa, abrasions on the left zygomatic region and scratch marks, respectively. Neither broken fingernails, etc. nor signs of external violence against the neck were found. autopsy revealed haemorrhages in the praevertebral cervical musculature and Simon's sign. Haemorrhagic pulmonary edema and cerebral edema were observed; blood alcohol concentration: 2.60 g/l, urine alcohol concentration: 3.26 g/l. As cause of death, positional asphyxia after blunt head trauma has to be considered as well as lethal ethanol intoxication. To us, alcoholisation attributed to the fall and together with unconsciousness following blunt head trauma circumvented self-rescue efforts, and therefore, aggravated the potentially lethal impact of positional restraint.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
2/9. Spinal epidural haematoma after blunt trauma to the neck and hyperflection of the cervical spine.Spinal epidural haematomas (sEDH) can be regarded as rare events, in principle a spontaneous and a traumatic aetiology can be distinguished. Spontaneous spinal epidural haematomas can arise, e.g. from vascular malformations, coagulopathies, etc. On the other hand, traumatic sEDH are related to, e.g. spinal trauma or intraoperative vascular injuries. With regard to clinical significance, spinal epidural haematomas accompanied by transient mild neurological symptoms up to lethal outcomes have been observed. We report on a 53-year-old male alcoholic who was found in the kitchen of his asylum in a grotesquely fixed body position, with his head and cervical spine in a maximum anteflected position. A general practitioner had ruled for a non-natural manner of death due to "broken neck" and alcohol intoxication, therefore, the prosecution authorities called for a medicolegal autopsy. At autopsy, paravertebral soft tissue haemorrhage in between the shoulder blades was disclosed. Furthermore, a spinal epidural haematoma, extending from the foramen magnum down to the middle portion of the thoracic spine was found. No fractures of vertebrae nor lesions of spine ligaments or bleedings of intervertebral discs were found. blood alcohol concentration was determined 1.92 g/l and urine alcohol concentration was 1.76 g/l. Further morphological findings were cerebral oedema and cardiac hypertrophy; the urinary bladder was found filled to bursting. Neuropathological investigations confirmed the presence of the spinal epidural haematoma and assigned lethal significance to this finding. There were no histological signs of axonal injury. Reconstruction revealed that when sitting on a chair in a drunk condition, the individual's upper part of the body had fallen backwards in the corner and subsequently got stuck with maximum anteflection of the head and cervical spine, causing rupture of vessels and spinal epidural haematoma. Acute respiratory failure caused by impairment of the phrenic nerve following spinal epidural haematoma with potential synergism of alcohol intoxication was ascertained as the cause of death.- - - - - - - - - - ranking = 1keywords = haemorrhage (Clic here for more details about this article) |
3/9. Traumatic rupture of intracranial vertebral artery due to hyperextension of the head: reports on three cases.In three cases of fatal basal subarachnoid hemorrhage due to rupture of the normal intracranial vertebral artery, the ruptures appeared to have been caused by overstretching of the vertebral artery from traumatic hyperextension of the head. In the first case, that of a 31-year-old male pedestrian who, while intoxicated, had been hit from behind by a car, symmetrically located bilateral complete and incomplete tearing of the vertebral arteries was found. In both of the other two cases, involving women aged 37 and 51 found dead after receiving fist blows to the face while intoxicated, complete rupture of the vertebral artery was found. The blood alcohol concentrations of the three cases ranged from 1.6 to 1.7 mg/g at autopsy.- - - - - - - - - - ranking = 6.5285045180262keywords = subarachnoid (Clic here for more details about this article) |
4/9. Fatal thrombosis of the basilar artery due to a minor head injury.A case is reported where a 20-year-old alcohol-intoxicated man was admitted to the hospital after a minor head injury. Initially there was no neurologic disturbances or complaints but after a few hours he became comatose, and he died 4 days later without regaining consciousness. The autopsy revealed no lesions of the upper cervical spine or the vertebral arteries, but the basilar artery was occluded in its entire length. No traumatic lesions could be seen by naked eye examination of the artery, and there was no accompanying subarachnoid haemorrhage. A thorough microscopic examination, however, using step-sectioning technique revealed a significant incomplete arterial rupture with an occluding luminal thrombosis superimposed, consisting predominantly of aggregated platelets. Only the very thin adventitia separated the vascular lumen from the subarachnoid space preventing the more well known fatal complication to a minor head injury: A subarachnoid haemorrhage. To the best of our knowledge, fatal thrombosis of the basilar artery due to a minor head injury has not previously been reported. The pathogenetic mechanism seems to be identical to that underlying fatal subarachnoid haemorrhage following a similar trauma apart from the resulting arterial rupture being incomplete instead of complete.- - - - - - - - - - ranking = 121.70208407164keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |
5/9. Subarachnoid haemorrhage due to upper cervical trauma.Seventeen cases are reported in which fatal subarachnoid haemorrhage was associated with injury to the upper cervical region. Most of these cases were alcohol-intoxicated, most had sustained their injuries in an altercation, and death was usually but not invariably rapid. It is proposed that trauma to the upper cervical region can cause subarachnoid haemorrhage, by a mechanism involving tracking of blood into the subarachnoid space from a damaged vertebral artery or one of its branches.- - - - - - - - - - ranking = 87.310890887104keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |
6/9. Isolated subarachnoid hemorrhage as a medicolegal problem.This study reviews 75 cases in which subarachnoid hemorrhages of the base of the brain have been experienced. The etiology of the cases is discussed as the question of trauma is of paramount importance. The period of the loss of consciousness is also an important factor. The other question in the etiology is whether the vertebral artery had been injured.- - - - - - - - - - ranking = 32.642522590131keywords = subarachnoid (Clic here for more details about this article) |
7/9. Cerebral intraventricular haemorrhage in a young adult.A case of a 26-year-old man who suffered a fatal intraventricular cerebral haemorrhage following an episode of trauma is described. The initial appearance at necropsy suggested a traumatic subarachnoid haemorrhage and initial investigation was directed towards the anterior neck structures and the vertebral arteries with negative results. dissection of the fixed brain showed a massive intraventricular bleed with secondary involvement of the subarachnoid space and dissection into the cerebral parenchyma. No bleeding points or natural disease of the cerebral vessels could be identified. The practical aspects of diagnosis and the cautious approach necessary in interpreting subarachnoid bleeding is emphasised. The significance of intraventricular haemorrhage following trauma has become more apparent with the advent of computed tomographic scanning. The implications for this and similar cases are considered.- - - - - - - - - - ranking = 57.448202220591keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |
8/9. Traumatic laceration of the intracranial vertebral artery causing fatal subarachnoid hemorrhage: case report.A 36-year-old man who had been drinking alcohol had a fatal subarachnoid hemorrhage immediately after suffering a moderate craniofacial injury. autopsy revealed a 3-mm longitudinal laceration of the left intracranial vertebral artery proximal to the posterior inferior cerebellar artery. There was no finding of arterial dissection. We discuss the mechanisms of the traumatic laceration of the vertebral artery in relation to traumatic dissection of the vertebral artery.- - - - - - - - - - ranking = 32.642522590131keywords = subarachnoid (Clic here for more details about this article) |
9/9. Traumatic baso-brainstem subarachnoid haemorrhage.Traumatic basal subarachnoid haemorrhage is an uncommon disorder that is well described in the forensic literature. The aetiology traditionally has been a relatively minor blunt trauma which is sustained typically at the level of the base of head and injures the arterial system to the brain. The site of trauma may be occult and not always demonstrable. In the case discussed, an acute baso-brainstem subarachnoid haemorrhage was caused by a severed extracranial vertebral artery due to a stabwound injury to the upper neck. A gravitational factor and alcohol intoxication, which might contribute to the basal intracranial haematoma, is given a novel thought.- - - - - - - - - - ranking = 230.34715910723keywords = subarachnoid haemorrhage, subarachnoid, haemorrhage (Clic here for more details about this article) |