Abstract 15- 1445-1500
Category: Clinical

At the end of the session, participants will be able to:

  1. Understand segmental vulnerability of the vertebral artery to injury and disease under a forensic
  2. Analyze the role of peripheral arteries examination and COL3A1 mutations testing in fatal vertebral artery
  3. Provide recommendations regarding the examination of vertebral arteries on forensic autopsies of fatal
    vertebral artery pathology cases.

COI Disclosure:

None to disclose


Dr. Fabio A. Tironi is a Brazilian anatomical and forensic pathologist. His previous experience includes Epidemiology, Forensic Pathology and teaching at the undergraduate level in his home country. He is currently a Research Fellow on Forensic Pathology at the Department of Laboratory Medicine and Pathobiology, University of Toronto, and Ontario Forensic Pathology Service, Toronto, ON, Canada.


Fabio A. Tironi 1, Sarathchandra Kodikara 2, Michael S. Pollanen 1

1 Department of Laboratory Medicine and Pathobiology, University of Toronto, and Ontario Forensic Pathology Service, Toronto, ON, Canada

2 Department of Forensic Medicine, University of Peradeniya, Kandy, Sri Lanka

    Target Audience:

    Pathologists, Residents, Medical Students

    Medical Expert (the integrating role), Communicator, Collaborator, Leader, Health Advocate, Scholar, Professional

    Pathology of the vertebral artery in medicolegal autopsies


    Objective:  Describe the clinicopathologic features of the vertebral artery (VA) in medicolegal autopsies. Methodology: Cases with fatal or significant VA pathology from 1996 to 2011 in the Provincial Forensic Pathology Unit, Toronto, were studied. Reports and histologic slides were reviewed. VA examination by segment and pathological findings were analyzed. Results: Twenty-six cases were included, 2.7 male to female ratio, 15 to 76 years. Fourteen cases (14/26, 54%) were trauma related, 11 cases (11/26, 42%) were non-traumatic, and 1 overlap (1/26, 4%). The 14 traumatic cases had mild to moderate external injuries. Thirteen of the 14 trauma cases (93%) had a basal subarachnoid hemorrhage (SAH) and showed transmural tears in the intracranial (V4) segment. The other trauma case had dissection between V1 and V2, associated with cerebellar, brainstem, and upper spinal cord (CBSUSC) infarctions. COL3A1 mutations and segmental mediolytic arteriopathy (SMA) were found among the cases. The eleven (42%) non-traumatic cases included basal SAH, CBSUSC and thalamic infarctions. VA thrombosis, atherosclerosis, dissection, fibromuscular dysplasia (FMD), SMA and COL3A1 mutations were present among cases. The overlap case presented upper posterior neck trauma and basal SAH due to a V3 dissection.  In this case, there was also FMD, SMA, multifocal intramural hemorrhages and dissections involving craniocervical and visceral arteries and a COL3A1 mutation was found. Conclusion: Traumatic rupture of V4 resulted frequently in SAH. Non-traumatic pathology predominately occurs in extracranial VA. We recommend that postmortem examination of these cases includes examination or the entire vertebral artery.