TRAUMATIC PONTO-MEDULLARY TEAR - A CASE-REPORT

The aim of this report is to demonstrate the correlation between an ex tremely short rime acting but strong force leading to incomplete ruptu re of the ponto-medullary junction (PMJ) accompanied by rupture of the basilar artery. Potential mechanisms involved in a combined hyperexte nsion and axial torsion of the head followed by characteristic lesions at the PMJ are discussed. A 33-year-old male suffered a blunt head in jury following a blow to the head, i.e. a head-butt. Resuscitation was performed for 45 min without success. At post mortem, there was a sup erficial periorbital haematoma on the right and a deep soft tissue bru ise in the right fronto-parieto-temporal area. but no evidence of skul l or dens axis fracture. A deep rear at the ponto-medullary junction w as identified with rupture of the basilar artery, whereas at the tip o f the tear, i.e. the floor of the IVth ventricle, only a thin tissue l ayer of about 2 mm remained intact. In contrast to the severity of the se lesions, only mild subarachnoid hemorrhage was observed, but the ve ntricular system was filled with blood clot resulting from the retrogr ade flow of subarachnoid hemorrhage.