Three Case Reports of Sudden Death as a Result of Hemorrhage Related to Vascular Malformation of Brain (original) (raw)

2003, The Bulletin of Legal Medicine

Santral sinir sisteminde gšrŸlen damar anomalileri; beyindeki damarlanma bozukluklarÝ sonucu olußurlar ve otopsilerde tesadŸfen saptanan kŸ•Ÿk lezyonlardan, šldŸrŸcŸ kafa i•i kanamalara neden olan bŸyŸk lezyonlara kadar farklÝ ßekillerde gš-rŸlebilirler. ‚alÝßmamÝzda 1998-2003 yÝllarÝ arasÝnda Adli TÝp Kurumu Morg Ühtisas Dairesinde ani šlŸm nedeni ile otopsileri yapÝlan ve šlŸm nedeni beyinde vaskŸler malformasyona baÛlÝ subaraknoidal ve intraserebral kanama olarak deÛerlendirilen Ÿ• olgu ele alÝndÝ. OlgularÝmÝzÝn yaßlarÝ 16-29 arasÝnda olup, ikisi erkek, biri kadÝndÝ. Makroskopik incelemede, beyin ve beyincik kÝvamÝnda yumußama, lgulardan birinde saÛ parietal lob yerleßimli, diÛer ikisinde de beyincik ve beyin sapÝ yerleßimli parankim i•i, intraventrikŸler ve subaraknoidal kanama alanlarÝ saptandÝ. Mikroskopik incelemede, beyin parankimi i•inde yerleßmiß birbirleri ile ilißkili ve kÝvrÝntÝlÝ sÝrt sÝrta vermiß damar yapÝlarÝ izlenmekteydi. DamarlarÝn bir kÝsmÝ ince duvarlÝ ve venšz yapÝda olmakla birlikte, •oÛu šzellikleri se•ilemeyen (ambigious) damarsal yapÝlardan olußmaktaydÝ. Damarlar arasÝnda nšral doku se•ilebilmekteydi. Makroskopik ve mikroskopik bulgular eßliÛinde olgularÝn ikisi arteriovenšz malformasyon baÛlÝ subaraknoidal ve intraserebral kanama olarak deÛerlendirildi. Olgularda šlŸmŸn vaskŸler malformasyona baÛlÝ patolojik beyin kanamasÝ sonucu meydana gelmiß ol-duÛu saptandÝ. FarklÝ klinik seyir gšsteren, bir kÝsmÝ ise klinik sessiz kalabilen bu olgular adli tÝp pratiÛinde ani šlŸm nedeni olarak karßÝmÝza •Ýkabilmektedir. Bu olgu sunumunun amacÝ nedeni a•Ýk•a ortaya konamayan šlŸm olgularÝnda sistematik otopsinin tÝp ve adalet a•ÝsÝndan deÛerini bir kez daha vurgula-maktÝr Anahtar kelimeler: Arteriyovenšz malformasyon, ani šlŸm, otopsi SUMMARY Vessel abnormalities seen in the central nervous system are the result of vascular malformations in brain and can be observed in various forms like little lesions determined at the autopsy to lesions leading to fatal intracranial haemorrhages. Our study includes three sudden death cases which were autopsied between 1998-2003 at the Morgue Specialization Department of the Council of Forensic Medicine. Cause of death was subarachnoidal and intracerebral haemorrhage due to vascular malformation in brain for all three cases. Age of our cases were between 16 to 29, two of them were male, and one was female. Macroscopic examination revealed softening of brain and cerebellum consistency, and inner parenchymal, intraventricular and subarachnoid hemorrhage areas with localisation on right parietal lobe in one case, and with localisation on cerebellum and brain stem in two cases. Microscopic examination showed folded vessel structures, connected and back to back with each other in brain parenchyma. Some of the vessels were thin walled and venous, but most of them were composed of ambigious vessel structures. Neural tissue could be differentiated between vessels. According to macroscopic and microscopic findings, the cases were considered as arteriovenous malformation, and related were subarachnoid and intracerebral hemorrhage. De-