Forensic Science, Medicine and Pathology

, Volume 15, Issue 1, pp 97–101 | Cite as

Fatal subarachnoid hemorrhage caused by rupture of variant anterior communicating artery: a case report and literature review

  • Runtao Ding
  • Xiaoming Xu
  • Dawei Guan
  • Baoli Zhu
  • Guohua Zhang
  • Xu WuEmail author
Case Report


Fatal subarachnoid hemorrhage (SAH) caused by anterior communicating artery (ACoA) rupture is a rare event in medicolegal practice. Anatomical variations of the ACoA tend to make its anatomical structure, and as a result, blood flow through it, more complicated, which may increase hemodynamic stress and cause weak spots in the affected blood vessels. Variant ACoAs are prone to rupture in the event of a blunt-force trauma. Here, we report a fatal case of SAH caused by the rupture of a variant ACoA when the victim’s head was struck from behind, causing the head to rotate and the victim to fall forward onto the ground. A medicolegal autopsy revealed diffuse basal SAH and ACoA duplication. The smaller of the two variant ACoA branches had ruptured near its junction with the right anterior cerebral artery. No basal aneurysms or other fatal diseases or injuries were found. This case highlights the significance of anatomical variation in forensic pathology.


Anterior communicating artery Variant·rupture Subarachnoid hemorrhage Fatal 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Ethical approval

This article does not contain any studies involving human participants or animals performed by the authors.

Informed consent

Informed consent was obtained from the decedent’s wife and son.


  1. 1.
    Liu J, Chen Y, Lan L, Lin B, Chen W, Wang M, et al. Prediction of rupture risk in anterior communicating artery aneurysms with a feed-forward artificial neural network. Eur Radiol. 2018;28:3268–75.CrossRefGoogle Scholar
  2. 2.
    Filter ER, Fernandes JR. Fatal traumatic subarachnoid hemorrhage due to assault-related tear of the basilar artery. J Forensic Legal Med. 2009;16:414–6.CrossRefGoogle Scholar
  3. 3.
    Ikegaya H, Yajima D, Iwase H. Vertebral artery rupture in a sudden death case after mild trauma. Am J Forensic Med Pathol. 2008;29:276–68.CrossRefGoogle Scholar
  4. 4.
    Kaiser C, Schnabel A, Berkefeld J, Bratzke H. Traumatic rupture of the intracranial vertebral artery due to rotational acceleration. Forensic Sci Int. 2008;182:15–7.CrossRefGoogle Scholar
  5. 5.
    Salvatori M, Kodikara S, Pollanen M. Fatal subarachnoid hemorrhage following traumatic rupture of the internal carotid artery. Legal Med. 2012;14:328–30.CrossRefGoogle Scholar
  6. 6.
    Bratzke H, Eisenmenger W. Traumatic rupture of the anterior communicating artery. Beitr Gerichtl Med. 1989;47:437–40.PubMedGoogle Scholar
  7. 7.
    Kardile PB, Ughade JM, Pandit SV, Ughade MN. Anatomical variations of anterior communicating artery. J Clin Diagn Res. 2013;7:2661–4.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Krzyzewski RM, Tomaszewski KA, Kochana M, Kopec M, Klimek-Piotrowska W, Walocha JA. Anatomical variations of the anterior communicating artery complex: gender relationship. Surg Radiol Anat. 2015;37:81–6.CrossRefGoogle Scholar
  9. 9.
    De Silva KR, Silva R, Gunasekera WS, Jayesekera RW. Prevalence of typical circle of Willis and the variation in the anterior communicating artery: a study of a Sri Lankan population. Ann Indian Acad Neurol. 2009;12:157–61.CrossRefGoogle Scholar
  10. 10.
    Ozaki T, Handa H, Tomomoto K, Hazama F. Anatomical variations of the arterial system of the base of the brain. Arch Jap Chir. 1977;46:3–17.Google Scholar
  11. 11.
    Fujimoto K, Tanaka O. Morphological examination of the circulus arteriosus cerebri humani (circle of Willis) I. Anterior and posterior communicating arteries. Acta Anatomica (Nippon). 1989;64:481–9.Google Scholar
  12. 12.
    Gross A. Traumatic basal subarachnoid hemorrhages: autopsy material analysis. Forensic Sci Int. 1990;45:53–61.CrossRefGoogle Scholar
  13. 13.
    Bunai Y, Nagai A, Nakamura I, Ohya I. Traumatic rupture of the basilar artery: report of two cases and review of the literature. Am J Forensic Med Pathol. 2000;21:343–8.CrossRefGoogle Scholar
  14. 14.
    Sato Y, Kondo T, Ohshima T. Traumatic tear of the basilar artery associated with vertebral column injuries. Am J Forensic Med Pathol. 1997;18:129–34.CrossRefGoogle Scholar
  15. 15.
    Djokic V, Savic S, Atanasijevic T. Medicolegal diagnostic value and clinical significance of traumatic incomplete tears of the basilar artery. Am J Forensic Med Pathol. 2003;24:208–13.PubMedGoogle Scholar
  16. 16.
    Dowling G, Curry B. Traumatic basal subarachnoid hemorrhage. Report of six cases and review of the literature. Am J Forensic Med Pathol. 1988;9:23–31.CrossRefGoogle Scholar
  17. 17.
    Contostavlos DL. Isolated basilar traumatic subarachnoid hemorrhage: an observer's 25 year re-evaluation of the pathogenetic possibilities. Forensic Sci Int. 1995;73:61–74.CrossRefGoogle Scholar
  18. 18.
    Ohshima T, Kondo T. Forensic pathological observations on fatal injuries to the brain stem and/or upper cervical spinal cord in traffic accidents. J Clin Forensic Med. 1998;5:129–34.CrossRefGoogle Scholar
  19. 19.
    Blaha M, Aaslid R, Douville CM, Correra R, Newell DW. Cerebral blood flow and dynamic cerebral autoregulation during ethanol intoxication and hypercapnia. J Clin Neurosci. 2003;10:195–8.CrossRefGoogle Scholar
  20. 20.
    Agrawal A, Kato Y, Chen L, Karagiozov K, Yoneda M, Imizu S, et al. Anterior communicating artery aneurysms: an overview. Minim Invasive Neurosurg. 2008;51:131–5.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Runtao Ding
    • 1
    • 2
    • 3
  • Xiaoming Xu
    • 1
  • Dawei Guan
    • 1
  • Baoli Zhu
    • 1
  • Guohua Zhang
    • 1
  • Xu Wu
    • 1
    Email author
  1. 1.School of Forensic MedicineChina Medical UniversityShenyangPeople’s Republic of China
  2. 2.Department of Forensic and Medical LaboratoryJining Medical UniversityJiningPeople’s Republic of China
  3. 3.Center of Forensic ScienceJining Medical UniversityJiningPeople’s Republic of China

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