Simple laboratory experiments to replicate some of the stresses on vertebro-basilar arterial walls. An investigation of possible mechanisms of traumatic subarachnoid haemorrhage

Farag, Atef; Franks, Antony J.; Gee, David

doi:10.1016/0379-0738(88)90173-9

Cited by 28 publications

(7 citation statements)

References 25 publications

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“…Some authors implicate torsional or distracting forces in the setting of rapid neck rotation [18], or direct arterial injury by fracture of the atlas [2]. Others suggest intrinsic sudden focal fluctuations in blood pressure and a ''bursting'' mode of rupture [19,20]. However, there has been little satisfactory insight as to why some people die of vertebral artery injury, despite the relatively benign nature of the injury in some cases.…”

Section: Discussionmentioning

confidence: 99%

Traumatic subarachnoid hemorrhage and the COL3A1 gene: emergence of a potential causal link

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Pollanen

2010

Forensic Sci Med Pathol

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We describe two previously unreported associations in four cases. The first two cases demonstrate an association between segmental mediolytic arteriopathy and vascular Ehlers-Danlos syndrome. The second two cases illustrate an association between vascular Ehlers-Danlos syndrome and traumatic subarachnoid hemorrhage. In case 1, there was acute subarachnoid hemorrhage and mesenteric artery dissection. In case 2, there was an acute mesenteric artery dissection with intestinal infarction. In both cases 1 and 2, segmental mediolytic arteriopathy was found in the vertebral arteries. Cases 3 and 4 were sudden deaths from traumatic subarachnoid hemorrhage with intracranial vertebral artery rupture. Genetic testing in all four cases revealed point mutations in the type 3 procollagen gene (COL3A1), as observed in vascular Ehlers-Danlos syndrome. Based on the first two cases, we propose that segmental mediolytic arteriopathy may be a marker for this disease. We further suggest that vascular Ehlers-Danlos syndrome may be related to the pathogenesis of traumatic vertebral artery injury, in some cases. We recommend that cases of segmental mediolytic arteriopathy and traumatic subarachnoid hemorrhage undergo genetic testing for COL3A1 mutations.

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Section: Discussionmentioning

confidence: 99%

Traumatic subarachnoid hemorrhage and the COL3A1 gene: emergence of a potential causal link

Pickup

Pollanen

2010

Forensic Sci Med Pathol

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“…It was also suggested by Coast and Gee that an indirect blow could be causing obstruction of the artery with abrupt rise in pressure in the intracranial portion [20]. One of the possible mechanisms presented by Farag et al is that of reversed blood flow in transiently occluded vertebral arteries [21].…”

Section: Discussionmentioning

confidence: 96%

Traumatic dissection of the vertebral artery in a toddler following a short fall

Kristoffersen

Vetti

Morild

2012

Forensic Science International

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“…8 Using an experimental model of the flow reversal hypothesis the characteristic longitudinal tears of the vertebral artery have been reproduced using cadaveric vertebral arteries. 9 We herein describe four cases with traumatic rupture of a vertebral artery and fatal subarachnoid hemorrhage in which we have found another histologic change in traumatized vertebral arteries. In addition to the characteristic longitudinal tear, we have observed discontinuous, non-circumferential, apparently necrotic regions of the tunica media.…”

mentioning

confidence: 85%

“…The free end of the artery was grasped with hemostats and the vessel was stretched manually until near rupture or rupture. Cadaveric vertebral arteries were also distorted using the method of Farag et al 9 with minor modifications. Following distortion, the mid portion of the vessel and the site of rupture was cut into sequential cross sections, fixed in neutral buffered formalin, processed for paraffin embedding, sectioned and stained using hematoxylin and eosin, and Masson's Trichrome.…”

Section: Physical Distortion Of Cadaveric Vertebral Arteriesmentioning

confidence: 99%

Lesions of the Tunica Media in Traumatic Rupture of Vertebral Arteries: Histologic and Biochemical Studies

Pollanen¹,

Deck²,

Boutilier³

et al. 1992

Can. j. neurol. sci.

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ABSTRACT:Discontinuous non-circumferential lesions of tunica media were observed in four cases of traumatic rupture of the vertebral artery. We hypothesize that these lesions were due to mechanical disruption of smooth muscle cells and the liberation of catabolic enzymes with subsequent degradation of the arterial media. To test this hypothesis, healthy vertebral arteries were incubated with crude extracts of bovine smooth muscle cytosol in attempt to reproduce the histological changes of the arterial media in traumatized vertebral arteries. We observed cytosol-induced degradation of tunica media, characterized by pallor of staining with the Masson’s Trichrome method, which was due to catabolic enzyme activity that was effectively inhibited by heat inactivation of the cytosol. The cytosol-induced tinctorial changes were similar to the lesions of the tunica media in naturally-occurring cases of traumatic vertebral artery rupture. We conclude that although vertebral arteries can be ruptured by physical distortion alone, associated lesions of the tunica media are due to in situ trauma-associated release of heat-labile catabolic enzymes.

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Simple laboratory experiments to replicate some of the stresses on vertebro-basilar arterial walls. An investigation of possible mechanisms of traumatic subarachnoid haemorrhage

Cited by 28 publications

References 25 publications

Traumatic subarachnoid hemorrhage and the COL3A1 gene: emergence of a potential causal link

Traumatic subarachnoid hemorrhage and the COL3A1 gene: emergence of a potential causal link

Traumatic dissection of the vertebral artery in a toddler following a short fall

Lesions of the Tunica Media in Traumatic Rupture of Vertebral Arteries: Histologic and Biochemical Studies

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