Document Detail


Differential diagnosis between traumatic and nontraumatic rupture of the intracranial vertebral artery in medicolegal autopsy.
MedLine Citation:
PMID:  19345129     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
We attempted to establish histopathological identification between traumatic rupture and nontraumatic arterial dissection of the intracranial vertebral artery (IVA) resulting in subarachnoid hemorrhage (SAH). Step-serial observations of ruptured IVAs among four traumatic and 44 nontraumatic SAH patients were investigated. We found that the most specific characteristic for differentiation was the shape of the ruptured adventitia. Extension of the adventitia was clearly observed in nontraumatic cases. In contrast, traumatic cases showed transmural ruptures. Other specific characteristics were also detected. For traumatic cases, small incomplete tears of intima and media were frequently found; they formed oblique tears without adventitial extension. Fragmentized internal elastic lamina was also observed in traumatic cases. In contrast, previous arterial dissections were frequently confirmed in nontraumatic cases. Medial degenerations or defects were detected in all nontraumatic cases. In these cases, the peripheral lesion of the rupture was appeared as intimal tears at recessed vascular wall caused by medial defects. This suggested a relationship between medial lesions and pathogenesis of arterial dissections. These additional features were found in both ruptured and non-ruptured intracranial arteries. We concluded that histopathological investigation is a reliable method for differential diagnosis between traumatic and nontraumatic rupture of the IVA resulting in fatal SAH. These morphological differentiations could be valuable for medicolegal diagnosis.
Authors:
Ayako Ro; Norimasa Kageyama; Akihiro Takatsu; Tatsushige Fukunaga
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Publication Detail:
Type:  Journal Article     Date:  2009-04-02
Journal Detail:
Title:  Legal medicine (Tokyo, Japan)     Volume:  11 Suppl 1     ISSN:  1873-4162     ISO Abbreviation:  Leg Med (Tokyo)     Publication Date:  2009 Apr 
Date Detail:
Created Date:  2009-05-26     Completed Date:  2010-01-26     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100889186     Medline TA:  Leg Med (Tokyo)     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  S66-70     Citation Subset:  IM    
Affiliation:
Department of Legal Medicine, School of Medicine, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan. chaeja@nifty.com
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Connective Tissue / pathology
Diagnosis, Differential
Elastic Tissue / pathology
Forensic Pathology
Humans
Male
Middle Aged
Rupture / diagnosis
Rupture, Spontaneous / diagnosis
Subarachnoid Hemorrhage / etiology,  pathology
Tunica Intima / injuries,  pathology
Tunica Media / injuries,  pathology
Vertebral Artery / injuries*,  pathology*

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