Infant life-threatening accidental head injury from 45 cm fall causing traumatic dissecting aneurysm and delayed rebleeding

Whilst short falls within the home are a common cause for infants under 12 months to present to hospital emergency departments, serious injuries or fatalities are exceptionally rare. Forensic evaluation of injuries is essential and considers a range of factors ascertained from investigation of the circumstances alongside findings from medical evaluations to consider injury plausibility. We report a case of a rare mechanism involving occipital-cervical distraction causing cerebrovascular dissection of the posterior inferior cerebellar artery and delayed rebleeding following a verified short distance fall of 45 cm from a sofa to highlight factors that assist in timely recognition of this injury which can be life-threatening or even fatal if overlooked.