title: Traumatic bilateral vertebral artery dissection.
abstract: Traumatic vertebral artery dissection is not often seen by forensic pathologists, and cases investigated are scarce in the forensic literature. We present the case of a 40-year-old woman cyclist who was struck by a car while wearing a helmet, and was neurologically near normal immediately thereafter at Emergency. She presented 48 h later with acute right hemiparesis, decreasing level of consciousness, and unsteadiness. CT revealed massive cerebellar infarction. CT angiography was normal. The patient died in coma 7 days after injury and autopsy revealed bilateral edematous cerebellar infarction and bilateral vertebral artery dissection. Rotational neck injury and mural tear in the wall of the Atlantic parts of both vertebral arteries is suggested as the possible mechanism of the arterial injury. Head and neck injuries are reported as a precipitating cause of vertebral artery injury. The possible influence of trauma may be further underestimated if longer intervals between vessel dissection and ischemia occur. The current case illustrates that "talk-and-die" syndrome may be due to occult vertebral artery dissection, possibly bilateral. In forensic cases of delayed death after mild trauma to the head and neck, the vertebral arteries should be examined for the cause of death.
authors.affiliation: Institut de Medicina Legal de Catalunya, Ciutat de la Justícia n° 111, Edifici G, Gran Via de les Corts Catalanes, Barcelona, Catalonia, Spain. ignasigaltes@gmail.com
authors.forename: Ignasi
authors.initials: I
authors.lastname: Galtés
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Borondo
authors.forename: Mònica
authors.initials: M
authors.lastname: Cos
authors.forename: Mercè
authors.initials: M
authors.lastname: Subirana
authors.forename: Carles
authors.initials: C
authors.lastname: Martin-Fumadó
authors.forename: Carles
authors.initials: C
authors.lastname: Martín
authors.forename: Josep
authors.initials: J
authors.lastname: Castellà
authors.forename: Jordi
authors.initials: J
authors.lastname: Medallo
mesh_terms: D000063:Accidents, Traffic; D000328:Adult; D001642:Bicycling / Q000293:injuries; D020203:Brain Stem Hemorrhage, Traumatic / Q000473:pathology; D002544:Cerebral Infarction / Q000209:etiology / Q000473:pathology; D004677:Encephalocele / Q000473:pathology; D005260:Female; D049429:Forensic Pathology; D006097:Granulation Tissue / Q000473:pathology; D006801:Humans; D019838:Neck Injuries / Q000150:complications* / Q000209:etiology; D010291:Paresis / Q000209:etiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery / Q000473:pathology; D020217:Vertebral Artery Dissection / Q000209:etiology / Q000473:pathology*