The tragic death of the Australian international cricketer, Phillip Hughes, occurred in November last year. He died after being struck to the side of the neck whilst attempting to hook a short pitched bouncer. After the strike he staggered for a moment before collapsing.
His death arose as a result of a dissection or tear of his vertebral artery; one of the arteries supplying the brain and housed within the arches of the vertebral column and the base of the brainstem, resulting in sub-arachnoid haemorrhage (which is bleeding that lies beneath a thin cellular layer that covers the brain).
Traumatic sub-arachnoid haemorrhage, as this entity is known, is a common occurrence in the forensic pathological setting. It is often seen as result of a punch or kick to the side of the face or neck, more frequently in alcohol intoxicated individuals. In contrast, it is rarely, if ever, described in boxers who are subject to frequent impacts on the head and neck. Although alcohol intoxication is a mainstay of many assaults, it is speculated that a boxer may anticipate impact and “tense” their musculature and possibly alcohol could also have an effect on the way the arteries respond to impact.
Any forensic pathologist seeing the footage from the game would have instantaneously known what has arisen. Yet by contrast, awareness of this condition is more limited amongst clinical / treating doctors. Doctors treating him suggested that the condition had only “been reported 100 times before”. An average forensic pathologist working in England and Wales will probably see one or two cases a year and thus the 100 world reported cases will be seen in around two to three years just in England in Wales alone. My own experience includes clinical doctors implicating a natural death (caused by a rupture of aneurysm on the same arterial system) which could have potentially been missed had the assault not been widely witnessed, but simply the majority of these cases do not survive to get to hospital.
This discordance raises a very important point about the different experiences and exposures a treating clinician will have compared to a forensic pathologist or similar expert in injury interpretation. Clinical doctors are ultimately there to treat and not to per se document or interpret injuries. Forensic pathologists, although medically and clinically trained, operate in the reverse role. It is therefore very important for the Courts to be cautious on accepting treating doctor’s clinical professional evidence as being expert (no matter how experienced the doctor is). Similarly avoid accepting clinical treatment by a forensic pathologist unless absolutely necessary.
Alexander Kolar is a Forensic Pathologist on the Home Officer Register covering the West Midlands region with increasing expertise in the field of forensic pathology. He is also co-editor of Mason's Forensic Medicine for Lawyers, Sixth Edition, which published in October 2015.