Basilar artery impingement secondary to longitudinal fracture of the clivus: A rare entity with postmortem computed tomography angiogram correlation

Abstract

Basilar artery entrapment secondary to fracture of the clivus is an extremely rare entity that is associated with high-energy head trauma. We report the first published example with postmortem computed tomography (CT) angiographic correlation with antemortem CT angiography findings, as well as macroscopic and histological confirmatory images. In this case, the head impact was secondary to a fall from a bar stool. Given how often head injuries are encountered in forensic pathology, it is possible that clivus fractures with vertebral or basilar artery entrapment are less rare than has previously been recognised. This entity warrants consideration in cases of non-immediate death following head trauma, especially where there is evidence of posterior circulation ischaemic injury. Where possible, postmortem CT angiography should be undertaken, with a view for further specialised dissection of the vertebral arteries and basilar artery where indicated.