J Pathol Transl Med.  2020 Mar;54(2):179-183. 10.4132/jptm.2019.10.15.

Inconspicuous longitudinal tears of the intracranial vertebral artery in traumatic basal subarachnoid hemorrhage

• Kim S

• KMID: 2501608
• DOI: http://doi.org/10.4132/jptm.2019.10.15

Abstract

Blunt force trauma to the head or neck region can cause traumatic basal subarachnoid hemorrhage (TBSAH), which can result in rapid loss of consciousness and death; however, detecting such a vascular injury is difficult. Posterior neck dissection was performed to investigate the bleeding focus in TBSAH cases 2018 and 2019. In all four cases, autopsies revealed a longitudinal tear in the midsection of the vertebral artery’s intracranial portion. The midportion of the intracranial vertebral artery appears to be most vulnerable to TBSAH. Interestingly, three of the cases showed only a vaguely visible longitudinal fissure in the artery without a grossly apparent tear; rupture was confirmed by microscopic examination. Longitudinal fissures of the intracranial vertebral artery, which are difficult to identify without detailed examination, may be overlooked in some cases of TBSAH. Thus, careful gross and microscopic examination of the vertebral artery is recommended in cases of TBSAH.

Keyword

Vertebral artery; Rupture; Basal subarachnoid hemorrhage; Trauma

Figure

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  Fig. 1. (A) A vague longitudinal fissure in the left vertebral artery (white arrow). (B) Water leakage through the ruptured portion. (C) Histology of the left vertebral artery at the point of rupture showing fibrinous material at the rupture site.

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  Fig. 2. (A) Longitudinal fissure in the left vertebral artery (white arrow). (B) Water leakage through the artificially ruptured portion of the proximal basilar artery (empty arrow). The true site of rupture is indicated (white arrow). (C) Histology of the true rupture site showing complete blockage by a fibrinous plug.

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  Fig. 3. (A) Longitudinal fissure in the left vertebral artery (white arrow). (B) Histology of the ruptured portion showing thrombus in the vascular lumen.

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