Fatal traumatic subarachnoid hemorrhage due to assault-related tear of the basilar artery.

Traumatic subarachnoid hemorrhage after blunt head injury or neck trauma most often occurs due to intracranial or extracranial vertebral artery rupture. A literature review confirms that subarachnoid hemorrhage related to basilar artery disruption is a rare event. Strong associations have been made between basal subarachnoid hemorrhage and relatively minor blunt force injuries to the face, head, or neck. Moreover, the degree of hemorrhage may appear striking and disproportionate to the external and internal evidence of injury. We present a case of an assault-related basilar artery tear causing fatal subarachnoid hemorrhage, despite minimal external injury. This report provides an overview of potential mechanisms accounting for vertebrobasilar system rupture, with application to our case. Crown Copyright 2009 Published by Elsevier Ltd.