Traumatic Vertebral Artery Injury

Abstract

Traumatic vertebral artery injury is frequently fatal from what may often be mild trauma to the head and neck. Detailed examination of vertebral arteries is not frequently undertaken at autopsy: the structural and histologic changes that may be relevant to the development of the injury are not well known. We sampled vertebral arteries bilaterally from 6 forensic autopsies (age = 26-50 years; 3 of 6 suffered from alcohol toxicity) with documented intradural vertebral artery injuries, and 4 nonvertebral-artery-injury-related autopsies (age = 19-70 years). Intradural, dural, and extradural components from each artery were submitted for paraffin-embedded tissue processing. Multiple serial sections and special stains (hematoxylin and eosin, alcian blue pH 2.5, reticulin, Congo red) were independently examined by 2 pathologists. All 6 of 6 injured samples and 4 of 4 control samples showed degenerative changes (intimal fibrosis, focal disruption of the internal elastic lamina, and medial calcification). However, microscopic adventitial hemorrhages were only observed around peripheral nerves adjacent to the injured samples. These may be due to tracking of blood along perineural loose connective tissue regions of reduced resistance, and may be a useful finding that points to underlying vertebral artery injury. Thus, careful dissection and gross and microscopic, examination of the vertebral arteries, with particular attention to the intracranial segments, is recommended in all cases of fatal traumatic head and neck injuries.

Subarachnoid haemorrhage secondary to traumatic intracranial aneurysm of the posterior cerebral circulation: case series and literature review

“…Alterations in local haemodynamics such as flow reversal and transient occlusion were found in an ex vivo study on vertebro-basilar vasculature to be sufficient to induce longitudinal tears in the vessel walls, which may lead to TICA formation. Histological features of the vessel wall, especially the adventitia, have been reported in the forensic literature to distinguish TICA from non-traumatic pathology [ 25 , 26 ]. In the PICA, the proximal segment and regions close to perforators are reported as vulnerable to trauma, possibly due to the anchoring effect of the perforators and vessel origin leading to shear stress when trauma is inflicted, causing a “tear out”.…”

Lesión de la arteria vertebral secundaria a trauma penetrante de cuello por arma corto-punzante

“…La lesión de la arteria vertebral es rara 6,7 en los servicios de urgencias y el mecanismo de lesión puede ser penetrante o no penetrante 6 ; corresponde de 3 a 19 % del total del trauma vascular cervical 8 .…”

“…Anatómicamente esta arteria se divide en cuatro segmentos 3,6,[9][10][11][12] (figura 1). En el trauma penetrante, el segmento más frecuentemente lesionado es el V3 10,13 .…”