Detection of arterial bleeding points in basilar subarachnoid hemorrhage by postmortem angiography

The most common cause of basal cerebral subarachnoid hemorrhage (SAH) is rupture of a cerebral artery aneurysm, but most reported series of SAH include cases where no aneurysm could be found. This would have no forensic relevance if all basal SAH would result from spontaneous ruptures of pathological blood vessels, but the situation is more complex because traumatic ruptures of otherwise normal cerebral arteries may be the only intracranial result of an injury. From the gross appearance, these two types of basal SAH cannot be distinguished. In victims with external injuries and in cases with doubtful circumstances, the detection and (histological) classification of the bleeding point(s) is necessary to distinguish between a spontaneous and traumatic origin of the rupture. We recommend post-mortem radiological examination of the cerebral arteries after instillation of a contrast medium. This method probably allows detection of even small bleeding points in the most inaccessible locations (not present in our actual series), and the radiological appearance of the bleeding points can also be helpful in the identification of the type of arterial alteration.