The histologic findings in seven cases of traumatic basal subarachnoid hemorrhage from rupture of a vertebral artery are reported. In all cases, blows to the head or neck resulted in minor injury to the cranial or cervical soft tissues but the ipsilateral intracranial segment of the vertebral artery was the site of a longitudinal transmural tear. In addition to rupture, the arterial wall proximal and distal to the site of rupture showed evidence of distortional injury of the tunica media. These traumatic lesions appeared as patchy anuclear regions of the media with distinctive pallor of smooth muscle staining. We propose that the forces which cause vertebral artery rupture stretch the artery along its long axis, thereby distorting the artery leading to this characteristic histologic change.
ABSTRACT:Eight cases of basal skull fracture with transverse fracture of the petrous temporal bone with medial extension to the internal carotid artery and lateral extension of the structures of the middle ear are described. Injuries in all cases were due to major blunt impact to the head usually occurring in a motor vehicle accident. General autopsy revealed major blood loss without any obvious external or internal site of hemorrhage suggesting that exsanguination was a complication of the head injury. The internal carotid arteries at the most medial extension of the fractures were lacerated or transected in all cases. In selected cases, the cervical internal carotid arteries were perfused and perfusate escaped rapidly from the ear(s) with the majority of fluid bypassing the cerebral venous system. Magnetic resonance image reconstruction of sequential sections of the fractured base of the skull confirmed the laceration of the internal carotid arteries and disruption of the middle ear. Based on this evidence, we propose that some displaced fractures of the base of the skull produce carotid-middle ear continuities which act as arterial shunts, resulting in rapid fatal exsanguination through the ear.
The authors detail a method of using a combination of vinyl polysiloxane impression material and methyl-methacrylate acrylic to produce weapon exemplars. Subsequent to this, these exemplar-wound devices were evaluated using thin-section computerassisted tomographic imaging. The techniques, uses and limitations of the technique with current technology are outlined.
RESUMELes details relies El une methods qui combine des materlaux d'empreinte El base de polysiloxane de vinyle ainsi que d'acrylique de methacrylate de rnethyle pour la production de modeles d'armes sont presentee, Suite El ce genre de manufacture, ces reproductions d'armes ont ete evaluees El I'aide de la tomographie par reconstruction d'image en coupe fine. Les techniques, leurs applications et leurs limitations sont mises en relief dans le contexte de la technologie courante.
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