A case of iatrogenic cerebral infarction demonstrated by postmortem cerebral angiography.
A 37-year-old man with a meningioma compressing the right frontal lobe underwent preoperative embolization of the feeding vessels from the right meningeal artery. Although the first challenge was apparently successful, an excess amount of embolization agent was accidentally injected during the next procedure. X-ray monitoring demonstrated flow of contrast medium into the right internal carotid, anterior and middle cerebral arteries, and then the patient suddenly developed left hemiparesis, nausea, and deep coma. He died 48 days after the embolization treatment without improvement of the coma. A medicolegal autopsy was performed to determine whether malpractice had occurred during the embolization procedure. An internal examination demonstrated massive necrosis of the cerebral hemispheres and lobar pneumonia with abscess in the lungs. Due to the extensive brain necrosis, it was impossible to carry out ordinary macroscopic examination to identify the precise site of the craniocerebral vessel occlusion. Postmortem angiography was therefore performed, and this successfully revealed occlusion of the right internal carotid artery. In this case, postmortem angiography played a key role in identification of the intracranial vascular lesion that was responsible for the iatrogenic cerebral infarction.
Tajima
Yutaka
Y
Department of Legal Medicine and Molecular Genetics, Gunma University, Graduate School of Medicine, Maebashi 371-8511, Japan.
Takagi
Rie
R
Kominato
Yoshihiko
Y
Kuwayama
Naoya
N
D000328:Adult; D001344:Autopsy; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000209:etiology*; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D017809:Fatal Outcome; D049429:Forensic Pathology / Q000379:methods*; D005625:Frontal Lobe / Q000000981:diagnostic imaging / Q000293:injuries; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008508:Medication Errors; D008576:Meningeal Arteries; D008577:Meningeal Neoplasms / Q000628:therapy*; D008579:Meningioma / Q000628:therapy*; D011183:Postoperative Complications
D003287:Contrast Media