Complete autoerotic asphyxiation: suicide or accident?

A case of a typical form of sexual asphyxiation is described, involving a young man hanging, in a context of autoerotic asphyxia. Multiple and different parameters are included in the definition.     

An unusual death by transcranial stab wound: homicide or suicide?

Penetrating stab wounds of the brain are uncommonly seen in modern times and occur almost exclusively in homicides. We report an unusual death by self-stabbing. A 24-year-old man was found dead at home, the handle of a kitchen knife protruding from his forehead. Data such as the psychiatric history of the victim, the multiplicity and site of wounds, the implement used, the presence of hesitation, and defense wounds were studied to elucidate the manner of death, and the suicidal nature of the event was established after police investigation. Atypical injuries require a careful forensic investigation, and medico-legal aspects of the differentiation between homicide and suicide are discussed in this particular case. A review of the literature revealed few cases of suicidal transcranial stab wounds.     

Vaginorectal impalement injury in a 2-year-old child--caused by sexual abuse or an accident?

Anogenital impalement injuries are rarely encountered in clinical or forensic practice. If seen in children and if incurred under suspect circumstances, sexual abuse must be considered in the differential diagnosis. Here we describe the case of a 2-year-old girl admitted to hospital with a vaginorectal impalement injury. According to the girl's parents, she had slipped in the bathroom and fallen onto the handle of an upright toilet bowl brush. Since a second slight anal injury was present, the parents' account appeared inconsistent. Therefore, physicians from the Institute of Legal Medicine were consulted to investigate the possibility of underlying sexual abuse. Because they could not rule out that the injuries could have been caused by sexual abuse, they recommended having the police immediately examine the site of the purported accident for evidence. The police and forensic investigations, however, verified the parents' account of an accidental injury. Thus, in this case, the initiation of a police inquiry, which is not compulsory in Germany even when sexual abuse is strongly suspected, led to the exoneration of the father.     

Death caused by a chain saw--homicide, suicide or accident? A case report with a literature review (with 11 illustrations)

A 31-year-old farm worker was found dead beside a chain saw. Based on the testimony of a colleague and because of the situation at the site, the police very soon presupposed an accident. It was assumed that the victim had slipped on the sudden ground and had been killed by the subsequent swerving of the saw when starting the engine. The body presented with a deep lacerated wound at the right side of the nape of the neck, including the first cervical vertebra, the medullary canal and the right mandible as well as multiple fissures of the occipital bone, which were attributed to repeated forceful use of the chain by another person. A second wound with relatively sharp edges and a tangential fissure in the corresponding area of the skull raised the suspicion that an axe or some similar device had been used. Although the forensic medical findings seemed to give clear evidence of external violence, no further investigations have been carried out so far by the authorities.     

The death of Kaspar Hauser (17 Dec 1833)--assassination, suicide or self-inflicted injury?

The death of Kaspar Hauser is described taking present medicolegal and criminological knowledge into account, the main question being whether the injury was self-inflicted, homicidal or suicidal. In spite of a critical retrospective analysis this question cannot be answered with sufficient certainty even from our modern perspective. It seems unlikely that the stab to the chest was inflicted exclusively for the purpose of self-damage, but both a suicidal stab and a homicidal act (assassination) cannot be definitely ruled out.     

Bumping into a knife--exculpatory statement or (tragic) accident?

Assessing stab wounds is a common task in forensic medicine. Quite often an accused claims that the victim bumped into the knife. Taking into account all the facts ascertained in the investigations conducted, such a statement can be rapidly disproved in most cases. The present case of a 14-year-old boy fatally wounded by his mother with a kitchen knife examines the aspect of walking into a knife. It is an example that this statement cannot always be regarded as implausible and that every single case has to be reconstructed in detail on the basis of all the investigation results.     

Subarachnoid Hemorrhage and Carbon Monoxide Exposure: Accidental Association or Fatal Link?

This case study reports a fatal subarachnoid hemorrhage (SAH) with concomitant accidental carbon monoxide (CO) exposure in 32‐year‐old man. Autopsy results indicated an antemortem aspiration of smoke, and a massive SAH was identified as the cause of death. Intriguingly, the carboxyhemoglobin level was 30%, suggesting that CO could have played a specific role. Intracranial hemorrhages following CO exposure in brain areas and tissues such as the basal ganglia, globus pallidus, or white matter are rare, but well characterized, whereas SAH related to CO exposure has not been previously described. In this case report, the possible role of CO, either as a primary cause or as a facilitating factor, in the pathogenesis of SAH is discussed. In particular, we propose the hypothesis that the excessive vasodilating effects produced by CO on the cerebral endothelium results in consequential loss of microvascular integrity.     

Intimate partner homicide,immigration and citizenship: evidence from Norway 1990–2012

Intimate partner homicides (IPH) are fatal violent attacks perpetrated by intimate partners. Immigrants are overrepresented in the IPH statistics as both perpetrators and victims. If explanatory factors for this are not studied, immigrants may be stigmatized. The present study investigates whether IPHs committed by immigrant perpetrators have characteristics that differentiate them from IPHs committed by the native majority of IPH perpetrators. All IPHs in Norway from 1990 to 2012 (N = 177) were included. Quantitative data were extracted through structured investigation of court documents. Information concerning risk factors (previous intimate partner violence and sociodemographic, contextual and clinical factors) was drawn from three validated risk assessment instruments. Univariate analysis and multivariate logistic regression analyses were conducted. When adjusted for other group differences, very few differences remained in the multivariate models. IPHs perpetrated by immigrants differed from cases with native perpetrators on modus operandi and ascribed motives and resulted in longer sentences than IPHs with native perpetrators. This study indicates considerable similarities in IPHs perpetrated by immigrants and natives. Findings indicating that IPHs by immigrants were perceived differently in the justice system need further investigation.     

Fatal overdoses of tramadol: is benzodiazepine a risk factor of lethality?

Tramadol is a centrally acting analgesic agent used in the treatment of mild to moderate pain. It has a low affinity to opioid receptors and inhibits the reuptake of norepinephrin and serotonin producing an analgesic action by blocking nociceptive impulses in the spine. Although 21 drug-combined fatalities including tramadol have been reported, only two fatal overdoses in adults with tramadol alone have been reported to date. We report four additional lethal intoxications, assess the toxicity of tramadol, the detection method and the possible interaction with other central nervous system (CNS) depressants, particularly benzodiazepines. Similarities between tramadol and buprenorphine are discussed, and a possible cytochrome P450-based interaction between tramadol and benzodiazepine is considered. To our knowledge, this relationship has never been reported in the literature.     

Gender differences in lethal violence: Historical trends in the relationship between homicide and suicide rates, 1960–2000

This study examines historical trends in the relationship between homicide and suicide rates and considers the extent to which gender differences exist in that relationship. From the perspective of the integrated homicide-suicide theory, gender differences in the homicidesuicide relationship stem from differences in the manner in which males and females attribute blame and responsibility for negative life events. Consistent with expectations, the data indicate that females engage in less homicide but in more suicide than males. Seemingly unrelated regression techniques were used to further examine gender differences in the relationship between homicide and suicide rates by analyzing U.S. data for 1960 through 2000. The results indicate more gender similarities than differences in that temporal trends in the production and direction of lethal violence for both males and females tend to be associated with similar social and economic factors.     

Death from renal cyst: spontaneous or traumatic rupture?

We report an unusual death of an apparently healthy 56-year-old male due to massive hemorrhage caused by rupture of an artery in the wall of a solitary renal cyst, possibly after a relatively minor trauma. Fatalities due to spontaneous or posttraumatic rupture of renal cysts are extremely rare but can represent a potential danger for people with acquired cystic kidney disease. Our report describes results of the forensic investigation and discusses possible mechanisms of the rupture.