Fatal subarachnoid hemorrhage due to traumatic rupture of the vertebral artery.

Massive fatal subarachnoid hemorrhage maximal in the posterior fossa following minor trauma to the head and neck was first attributed to rupture of a vertebral artery (VA) in 1971. Typically, a young, healthy, but intoxicated man receives a minor blow and immediately collapses and dies within minutes. Early reports suggested an extracranial site of rupture with upward tracking of blood into the subarachnoid space. In few cases has this site of rupture been histologically verified, and more recent reports have drawn attention to intracranial rupture of the VA. We describe herein six cases in which the intracranial segment of the VA was the site of traumatic rupture, a site which can be demonstrated by careful examination of the most proximal segment of the VA attached to the brain in the course of routine brain removal.