Hostname: page-component-5c6d5d7d68-7tdvq Total loading time: 0 Render date: 2024-08-19T00:48:05.324Z Has data issue: false hasContentIssue false
  • English
  • Français

Fracture of Temporal Bone With Exsanguination: Pathology and Mechanism

Published online by Cambridge University Press:  18 September 2015

M.S. Pollanen ,
J.H.N. Deck ,
B. Blenkinsop  and
E.M. Farkas
M.S. Pollanen
Affiliation:
Department of Pathology, Division of Neuropathology, The Toronto Hospital, Toronto
J.H.N. Deck*
Affiliation:
Department of Pathology, Division of Neuropathology, The Toronto Hospital, Toronto Forensic Pathology Branch, Coroner’s Office, Toronto
B. Blenkinsop
Affiliation:
Forensic Pathology Branch, Coroner’s Office, Toronto
E.M. Farkas
Affiliation:
Department of Pathology, Division of Neuropathology, The Toronto Hospital, Toronto
*
Department of Pathology, Division of Neuropathology, The Toronto Hospital, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Eight cases of basal skull fracture with transverse fracture of the petrous temporal bone with medial extension to the internal carotid artery and lateral extension of the structures of the middle ear are described. Injuries in all cases were due to major blunt impact to the head usually occurring in a motor vehicle accident. General autopsy revealed major blood loss without any obvious external or internal site of hemorrhage suggesting that exsanguination was a complication of the head injury. The internal carotid arteries at the most medial extension of the fractures were lacerated or transected in all cases. In selected cases, the cervical internal carotid arteries were perfused and perfusate escaped rapidly from the ear(s) with the majority of fluid bypassing the cerebral venous system. Magnetic resonance image reconstruction of sequential sections of the fractured base of the skull confirmed the laceration of the internal carotid arteries and disruption of the middle ear. Based on this evidence, we propose that some displaced fractures of the base of the skull produce carotid-middle ear continuities which act as arterial shunts, resulting in rapid fatal exsanguination through the ear.

Type
Articles
Information
Canadian Journal of Neurological Sciences , Volume 19 , Issue 2 , May 1992 , pp. 196 - 200
Copyright
Copyright © Canadian Neurological Sciences Federation 1992

References

1.Adams, JH, Graham, DI, Scott, G, Parker, L, Doyle, D.Brain damage in fatal non-missile head injury. J Clin Pathol 1980; 33: 1132–1145.CrossRefGoogle ScholarPubMed
2.Freytag, E.Autopsy findings in head injuries from blunt forces. Statistical evaluation of 1,367 cases. Arch Pathol 1963; 75: 402–413.Google Scholar
3.Ghorayeb, BY, Rafie, JJ.Fractures of the petrous bone. An evaluation of 123 cases. Annales D Oto-Laryngolgie Et De Chirurgie Cervico-Facial 1989; 106: 294–301.Google ScholarPubMed
4.Gianoli, GJ, Amedee, RG.Temporal bone fractures. J Louisiana State Med Soc 1989; 141: 11–13.Google ScholarPubMed
5.Murakami, M, Ohtani, I, Aikawa, T, Anzai. Temporal bone findings in two cases of head injury. J Laryngol Otol 1990; 104: 986–989.CrossRefGoogle ScholarPubMed
6.Cannon, CR, Jahrsdoerfer, RA.Temporal bone fractures. Review of 90 cases. Arch Otolaryngol 1983; 109: 285–288.CrossRefGoogle ScholarPubMed
7.Ghorayeb, BY, Yeakley, JW, Hall, JW, Jones, BE.Unusual complications of temporal bone fractures. Arch Otolaryngol Head Neck Surg 1987; 113:749–753.CrossRefGoogle ScholarPubMed
8.Waldron, J, Hurley, SE.Temporal bone fractures: a clinical diagnosis. Arch Emerg Med 1988; 5: 146–150.CrossRefGoogle ScholarPubMed
9.Cinelle, PB, Herrera, AH.Cranial base hemorrhage. Arch Otolaryngol Head Neck Surg 1991; 117: 212–213.CrossRefGoogle Scholar