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Schneller postmortaler röntgenologischer Nachweis einer Blutungsquelle bei tödlichen basalen subarachnoidalen Blutungen

Rapid postmortem x-ray detection and classification of the source of fatal subarachnoid hemorrhages of arterial origin

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Zusammenfassung

Bei der forensischen Untersuchung tödlicher Subarachnoidalblutungen geht es mitunter um die Abgrenzung zwischen einer Spontanblutung und einem traumatischen Geschehen. Dies ist erst nach einer Identifizierung der Blutungsquelle und der Art der Gefäßläsion möglich. Die konventionellen Nachweismethoden einer Aneurysmaruptur basieren auf einer zeitraubenden Präparation des Circulus arteriosus Willisii. Dabei können präparationsbedingte Artefakte in Form von Gefäßeinrissen entstehen; trotz aller Mühe werden die Blutungsquellen so auch nicht in jedem Fall gefunden. Eine einfache röntgenologische Darstellungsmethode mit Einführen eines Kontrastmittels in die A. vertebralis und A. carotis interna während der Obduktion kann frühzeitig die Rupturstelle anzeigen. Unterschiedliche Röntgenbefunde von traumatischer und spontaner Subarachnoidalblutung können (bei bisher nur sehr begrenzter Erfahrung) sogar einen Hinweis auf die Art der Gefäßläsion geben. In jedem Fall wurde bei uns eine gezielte Untersuchung der geschädigten Gefäßregion erleichtert.

Abstract

Cases of death due to basal cerebral subarachnoid hemorrhages are regularly observed in forensic autopsy material, mostly in the group sudden and unexpected death. The most frequent causes for such bleedings are ruptures of aneurysms of the major cerebral arteries. In forensic literature it is known that traumatic ruptures of otherwise normal cerebral arteries can be the only intracranial result of an external injury (often assaults) and that such cases present general and intracranial findings quite similar to deaths due to spontaneous bleeding. We recommend postmortem radiological examination of the cerebral arteries using contrast material and present the findings in our at present, small series of cases. The radiological appearance of the bleeding site in a case of traumatic subarachnoid hemorrhage was quite different from that in aneurysms. At least in some cases the postmortem x-ray examination seems not only to simplify the detection of the bleeding site, but also to be helpful in the diagnosis of the type of the vessel lesion.

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  1. Institut für Rechtsmedizin, Campus Benjamin Franklin, Charité-Universitätsmedizin, Berlin

    E. Ehrlich & H. Maxeiner

  2. Institut für Rechtsmedizin, Campus Benjamin Franklin, Charité-Universitätsmedizin, Hittorfstr. 18, 14195 , Berlin

    E. Ehrlich

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  1. E. Ehrlich
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  2. H. Maxeiner
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Ehrlich, E., Maxeiner, H. Schneller postmortaler röntgenologischer Nachweis einer Blutungsquelle bei tödlichen basalen subarachnoidalen Blutungen. Rechtsmedizin 15, 79–85 (2005). https://doi.org/10.1007/s00194-004-0303-1

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