Injuries: traumatic basal subarachnoid haemorrhage: practice question

A Forensic Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Forensic Medicine · Injuries: traumatic basal subarachnoid haemorrhage

Sample item

A young man collapses within minutes of a slap on the side of the neck below the ear during a quarrel. Autopsy shows no skull fracture and no aneurysm, but there is massive basal subarachnoid haemorrhage. The most likely source is:

ATear of the bridging veins over the cerebral convexityBTear of the middle meningeal arteryCRupture of the vertebral artery near the atlanto-occipital region from sudden rotation or extension of the neckDRupture of a berry aneurysm of the anterior communicating artery

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Rupture of the vertebral artery near the atlanto-occipital region from sudden rotation or extension of the neck

A blow to the side of the neck that suddenly rotates or hyperextends the head can tear the vertebral artery where it loops around the atlas, giving basal subarachnoid haemorrhage with no skull fracture or aneurysm. The finding must be sought with dissection of the vertebral arteries. Extradural bleeding follows temporal fracture, and subdural bleeding follows bridging vein tears.

Option by option

A. Tear of the bridging veins over the cerebral convexity
Bridging vein tears cause convexity subdural haematoma, not basal subarachnoid haemorrhage.
B. Tear of the middle meningeal artery
Middle meningeal tear causes extradural haematoma with temporal fracture.
C. Rupture of the vertebral artery near the atlanto-occipital region from sudden rotation or extension of the neck (correct)
Correct. Vertebral artery rupture from neck movement explains basal bleeding with no aneurysm.
D. Rupture of a berry aneurysm of the anterior communicating artery
A berry aneurysm was excluded at autopsy in this case.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Forensic Medicine question

What is the answer to this Forensic Medicine question?

The best answer is C, Rupture of the vertebral artery near the atlanto-occipital region from sudden rotation or extension of the neck. A blow to the side of the neck that suddenly rotates or hyperextends the head can tear the vertebral artery where it loops around the atlas, giving basal subarachnoid haemorrhage with no skull fracture or aneurysm.

Why is "Tear of the bridging veins over the cerebral convexity" not the answer?

Bridging vein tears cause convexity subdural haematoma, not basal subarachnoid haemorrhage.

Why is "Tear of the middle meningeal artery" not the answer?

Middle meningeal tear causes extradural haematoma with temporal fracture.

Why is "Rupture of a berry aneurysm of the anterior communicating artery" not the answer?

A berry aneurysm was excluded at autopsy in this case.

What concept does this question test?

It tests Injuries: traumatic basal subarachnoid haemorrhage in Forensic Medicine. The finding must be sought with dissection of the vertebral arteries. Extradural bleeding follows temporal fracture, and subdural bleeding follows bridging vein tears.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Injuries: traumatic basal subarachnoid haemorrhage?

Learn postmortem changes with their timelines, and toxicology as poison, sign, test and antidote. Then use the flashcards and the other Forensic Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.