Vertebral artery laceration mimicking elder abuse

Area of Science:

• Forensic Pathology
• Gerontology
• Trauma Analysis

Background:

• Elder abuse is a significant public health issue, with physical abuse being a severe manifestation.
• Assessing elder abuse homicides is challenging, particularly differentiating inflicted trauma from accidental injuries.
• The incidence of elder abuse is expected to rise with the growing elderly population.

Observation:

• A 94-year-old male with reported fall from a wheelchair presented with unresponsiveness and respiratory distress.
• Autopsy revealed periorbital contusions and neck hemorrhage, initially suggestive of strangulation or blunt force trauma.
• A C5 vertebral body fracture and left vertebral artery laceration were identified, causing a retropharyngeal hematoma.

Findings:

• The neck trauma was attributed to a vertebral artery laceration at C5, not strangulation or typical blunt force trauma.
• Unlike common vertebral artery injuries, this case did not involve the C1-C2 levels or result in subarachnoid hemorrhage.
• The retropharyngeal hematoma was the primary cause of airway and vascular compromise.

Implications:

• This case underscores the critical need for meticulous forensic examination to accurately determine the cause of death in suspected elder abuse.
• Distinguishing inflicted trauma from accidental injury is crucial for legal and ethical reasons in elder abuse cases.
• Forensic pathologists must consider rare injury patterns, such as C5 vertebral artery laceration, in the differential diagnosis of neck trauma.