Post-traumatic aneurysmal rupture involving the circle of Willis affected by fibromuscular dysplasia. A case report and systematic review |
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| Affiliation: | 1. Institute of Human Anatomy, Department of Neurosciences, University of Padova, Padova, Italy;2. Medico-Legal Private Practitioner, Padova, Italy;1. School of Medicine, University of Michigan, Ann Arbor, Michigan, USA;2. Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA;1. Department of Radiological Technology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan;2. Department of Radiology, University of Tokyo Hospital, Tokyo, Japan;3. Department of Neurosurgery, University of Tokyo Hospital, Tokyo, Japan;4. Department of Computational Diagnostic Radiology and Preventive Medicine, University of Tokyo Hospital, Tokyo, Japan;5. Department of Radiology, Nihon University School of Medicine, Tokyo, Japan;6. Department of Radiology, Juntendo University, Tokyo, Japan;7. Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan;1. Department of Biomedical Sciences, University of Padova, Via Bassi 58, I-35131 Padova, Italy;2. Centre for Mechanics of Biological Materials, University of Padova, Via A. Gabelli 65, 35127 Padova, Italy;3. Department of Industrial Engineering, University of Padova, Via Venezia 1, I-35131 Padova, Italy;4. Rheumatology Unit, Department of Medicine − DIMED, University Padova, 35128 Padova, Italy;5. Musculoskeletal Pathology and Oncology Laboratory, Department of Orthopedics and Orthopedic Oncology, 35128 University of Padova, Italy;6. Clinica Medica 3, Department of Medicine − DIMED, University of Padova, 35128 Padova, Italy;7. RAMSES Laboratory, RIT Department, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy;8. Department. of Pediatric Orthopedics and Traumatology, IRCCS Istituto Ortopedico Rizzoli Bologna, Italy;9. Department of Orthopedics and Orthopedic Oncology, 35128 University of Padova, Italy;10. Institute of Human Anatomy, Department of Neuroscience, University of Padova, Via A. Gabelli 65, 35127 Padova, Italy;1. Department of Radiology, Faculty of Medicine, Duzce University, Duzce, Turkey;2. Department of Forensic Medicine, Faculty of Medicine, Sakarya University, Sakarya, Turkey;3. Department of Emergency Medicine, Faculty of Medicine, Duzce University, Duzce, Turkey |
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| Abstract: | The fatal rupture of a saccular aneurysm at the junction between the left anterior cerebral artery and anterior communicating artery affected by fibromuscular dysplasia (FMD) is a rare condition. Here is reported the case of a subject involved in a road traffic accident a few minutes before the death, which opened the debate on the real cause of death in a forensic setting.By autopsy, the examination of the brain revealed subarachnoid haemorrhage with flooding of the ventricles due to the breached saccular aneurysm of the junction between the left anterior cerebral artery and anterior communicating artery, in FMD mainly affecting the circle of Willis arteries. A spontaneous aneurysmal rupture was excluded on the basis of probabilistic analysis, in the presence of alternative hypotheses that could explain the facts. The passenger’s delayed loss of consciousness may be explained as much by a hypertension-linked rupture of the aneurysm triggered by the emotional stress experienced, as by the traumatic shaking/impact of the aneurysm against the bony skull structures, in a subject predisposed to aneurysm frailty due to FMD.Overall, the concausal role of both the road traffic accident, typified by high kinetic energy, and the presence of a pre-existing aneurysmatic weakness due to FMD is fully recognized.The identification of anatomical variants, jointly with uncommon diseases at the examination of the brain base arteries in any case of isolated basal subarachnoid haemorrhage, may avoid wrong legal consequences even when the cause of death seems to be obviously of simple traumatic origin. |
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| Keywords: | Fibromuscular dysplasia Anterior communicating artery Anterior cerebral artery Aneurysm Anatomical variation Road traffic accident |
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