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Traumatic dissection of the vertebral artery in a toddler following a short fall

Stine Kristoffersen1, Nils Vetti, Inge Morild

  • 1Department of Pathology, Haukeland University Hospital, Bergen, Norway. stine_k@hotmail.com

Forensic Science International
|May 29, 2012
PubMed

Insights

A rare case of accidental vertebral artery dissection causing subarachnoid hemorrhage (SAH) in a toddler highlights the importance of considering trauma in pediatric SAH. This finding underscores the need to differentiate accidental injury from abusive head trauma.

Area of Science:

  • Pediatric Neurology
  • Forensic Pathology
  • Neuroradiology

Background:

  • Subarachnoid hemorrhage (SAH) in children is uncommon, with causes including aneurysms and other disorders.
  • Traumatic SAH can result from head injury or child abuse, necessitating careful diagnosis to avoid false accusations.

Observation:

  • A nearly two-year-old girl presented with unconsciousness, elevated intracranial pressure, SAH, and bilateral retinal hemorrhages (RH) after a witnessed fall.
  • Premortem angiography revealed a right vertebral artery dissection, and postmortem examination showed a deep neck lesion.

Findings:

  • Cerebral edema, SAH, and RH are suggestive of abusive head trauma, but crucial indicators like external or skeletal lesions were absent.
  • The absence of typical abusive head trauma markers, coupled with the vertebral artery dissection, points towards an accidental fall as the cause.

Implications:

  • This case suggests accidental vertebral artery dissection can cause SAH in toddlers, a previously undescribed mechanism.
  • Accurate diagnosis is critical, as misinterpreting findings can lead to serious legal implications for caregivers.

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