How She Died The puck that struck Brittanie Cecil in the left temple fractured her skull, but the cause of her death was a blood clot in a vertebral artery

It doesn't take a neurosurgeon to deduce that a frozen hockey
puck moving at 100 mph is a potentially deadly projectile. When
Espen Knutsen's deflected slap shot struck Brittanie Cecil in
the left temple on March 16, it fractured her skull and bruised
her brain on impact. But it didn't kill her. Not on impact,
anyway. Brittanie died as a result of an exceptionally uncommon
blood clot, caused when her head snapped back violently as she
was hit.

After Brittanie was struck, she retained consciousness and was
taken by ambulance to Columbus Children's Hospital for
observation and to receive stitches for a small gash. In the
emergency room she suffered a seizure and was admitted to the
hospital. But she recovered quickly, and by the next day she was
conscious, communicative and able to walk around in the
hospital. She didn't complain of much neck pain or suffer
symptoms such as confusion or dizziness that might have served
as warning signs. "I think everyone's impression was that she
was doing fine," says Franklin County coroner Brad Lewis.

But what Brittanie's doctors didn't know was that she had
suffered a tear to her right vertebral artery, which supplies
blood to the back of the brain. (The CAT scan performed when
Brittanie was in the hospital did not reveal the tear.) The torn
artery developed a clot that increased steadily in size, so much
so that it inhibited the blood supply to Brittanie's brain. As
less and less blood flowed, the clot continued to expand.

On the morning of March 18, Brittanie developed a high fever and
lost consciousness. Lewis believes that the swelling became so
severe that it compressed the three other main arteries that
supply blood to the brain. By the time doctors performed an
angiogram that revealed the blocked arteries, they were
powerless to reverse the damage. She died at 5:15 p.m., nearly
48 hours after she had been struck and two days shy of her 14th
birthday. "This is just an incredibly rare thing," David
Milzman, a Georgetown University emergency room doctor and
expert on hockey injuries, told The Columbus Dispatch. "I
wouldn't have thought of that, and anyone who says they would
have is lying." --L. Jon Wertheim

COLOR DIAGRAM: ILLUSTRATIONS BY JARED SCHNEIDMAN

TWO COLOR DIAGRAMS: ILLUSTRATIONS BY JARED SCHNEIDMAN Brittanie was sitting in Section 121, Row S, Seat 11 when the puck struck her, hit a man in the back of his head, then knocked out a girl's tooth. Brittanie was bleeding from a gash on her head (right) but walked to the first-aid station.

COLOR PHOTO: FOX SPORTS NET [See caption above]

COLOR DIAGRAM: ILLUSTRATIONS BY JARED SCHNEIDMAN Knutsen's shot deflected off Morris's stick, flew over goalie Roman Turek, cleared a nearly 12-foot-high section of board and glass and wreaked havoc in the seats.

1 The puck struck Brittanie's left temple, fracturing her skull
and bruising her brain.

2 The impact snapped her head back violently, tearing her right
vertebral artery.

The right vertebral artery supplies blood to the back of the
brain.

3 A clot developed in the torn artery and grew to the point that
it inhibited blood flow.