Homicide-suicide by a single gunshot to the head

Apart from typical suicides, there are sometimes unusual deaths from gunshots to the head. The presented case is a double death from the autopsy material of the Institute of Legal Medicine in Berlin. The report deals with a murder-suicide of a man, who killed himself and his 2-year-old daughter by a single gunshot. After having administered a tranquilizer to the child, he held her head to his own and fired a contact shot to his right temple so that the bullet passed through both heads.     

Continued physical capacity after head gunshot injury

The human brain shows a very high density of functionally important structures. Even small lesions may therefore cause clinical symptoms. Penetrating gunshots to the head are presumed to cause immediate incapacitation by subsequent disturbance of cerebral functions. The authors discuss anatomical and functional principles of the terms action, capacity to act and incapacitation and report two illustrative cases with lack of incapacitation following gunshots to the head.     

Perforating gunshot to the head with a power-actuated tool

The article describes a shortly survived suicide with a powder-actuated tool. A 51-year-old man shot all through his head from the right to the left temple. The pin produced an extensive area of destruction in the brain tissue, but neither in the hospital nor during the autopsy was any projectile found. Finally the pin was detected in a metal fitting of the bed in which the man had killed himself. The suicide instrument was a powder-actuated tool firing a metal pin after igniting a cartridge. Unlike a nail gun using compressed air, pins fired by means of a propellant reach a velocity of up to 150 m/s thus developing a higher destructive potential.     

Suicidal gunshot to the head while driving a car

A severe traffic accident occurred on the German autobahn. According to eye witnesses, the car had changed from the left to the right lane at 160 km/h before crashing into a thicket at full speed. In the car, a sports pistol was found in the footwell of the driver's side. The emergency doctor who performed the external examination of the victim's body found a gunshot wound in the region of the driver's right lower jaw. As the prosecutor released the body without further examination, the family of the suicide asked for an autopsy, which demonstrated a lethal suicidal gunshot to the head; toxicological tests proved a previous consumption of cocaine.     

Suicidal single gunshot injury to the head: differences in site of entrance wound and direction of the bullet path between right- and left-handed--an autopsy study

The aim of this study was to determine the differences in the anatomical site of a gunshot entrance wound and the direction of the bullet path between right- and left-handed subjects who committed a suicide by a single gunshot injury to the head. The retrospective autopsy study was performed for a 10-year period, and it included selected cases of single suicidal gunshot head injury, committed by handguns. We considered only contact or near-contact wounds. The sample included 479 deceased, with average age 47.1 ± 19.1 years (range, 12-89 years): 432 males and 47 females, with 317 right-handed, 25 left-handed, and 137 subjects with unknown dominant hand. In our observed sample, most cases involved the right temple as the site of entrance gunshot wound (about 67%), followed by the mouth (16%), forehead (7%), left temple (6%), submental (2%), and parietal region (1%). The left temple, right temple, and forehead were the sites of the gunshot entrance wounds, which were the best predictors of the handedness of the deceased (Spearman ρ = 0.149, P = 0.006). Our study showed that the direction of the bullet intracranial path in cases of suicide was even a more potent predictor of the handedness of the deceased (Spearman ρ = 0.263, P = 0.000; Wald = 149.503, P = 0.000).     

Brain injury after survived gunshot to the head: reactive alterations at sites remote from the missile track

Gunshot wounds to the brain usually lead to acute respiratory arrest or death after a brief survival period, even in cases involving only slight direct tissue damage. It can be assumed therefore that the damage extends beyond the zone of recognizable destruction and hemorrhages. To determine the true extent of the tissue injury resulting from gunshot wounds to the brain, we carried out microscopic investigations for reactive changes (emigration of leukocytes and macrophages, axonal expression of beta-amyloid precursor protein (beta-APP) in 10 cases of gunshot wound to the narrow channel of the brain with survival times >2h. Demonstration of leukocytes expressing naphthol AS-D chloroacetate esterase activity in the brain tissue at the border of the missile track established the vitality of the gunshot effect. The presence of macrophages (CD68-epitope) allowed demarcation of a 1-2mm wide necrotic zone around the permanent cavity. Within this zone and beyond, beta-APP showed an initial increase followed by a decline in the number of injured axons. Three types of beta-APP positive staining could be differentiated. In the immediate vicinity of the missile track beta-APP positive neurons were present at a distance of 2-4mm from the margin of the permanent cavity (type 1) as a result of primary injured neuronal tissue by the gunshot itself. At longer distances from the narrow channel and the permanent cavity single beta-APP positive axons or axon fragments and two additional types were found; type 2 shows a parallel, wave-like arrangement of the damaged fibers, which suggests that the injury was produced by mechanical acceleration of the brain tissue created by the energy the projectile expended within the brain; irregular aggregation of beta-APP positive axons or axon fragments within a local edema represents type 3, which may be attributed to secondary ischemia or edema.     

Suicidal gunshot wounds to the head: a retrospective review of 406 cases

A retrospective review of 406 suicidal gunshot wounds to the head, investigated at the Medico-Legal Laboratory of Pretoria, between 1997 and 2000 was performed. Fifty-seven percent of fatal suicidal firearm injury to the head occurred in the 21- to 40-year age range in both male and female victims. Eighty-two percent of all these victims of suicidal firearm fatalities to the head were male. Of the 406 cases, 63% were white, 31% were black, and 6% were of mixed ethnic and/or Asian decent. There was a slight increase in incidence around spring and autumn. Handguns were used in the majority of cases with shoulder weapons being used in 18 of the 406 cases. Ninety-two percent of the suicidal gunshot wounds to the head occurred indoors. A positive blood alcohol concentration was seen in 40% of cases. Of those examined, 81% were contact gunshot wounds. The trajectory was upward in 51% of cases and horizontal in 24% of cases. The right temple was the most common entrance gunshot wound site. Findings are in keeping with previously published literature.     

Multiple gunshot wounds of the head: an anthropological view

A decomposed body was judged at the scene to have two gunshot wounds of the thorax and three of the head. Confirmed at autopsy, the condition of the remains precluded conclusions about the precise nature of the defects. Preparation and reconstruction of the skull disclosed seven large cranial defects and a series of fractures. This preparation allowed the application of well-known principles of gunshot wound analysis. Although the analysis of specific gunshot wound defects is well covered in the literature, there are few examples of the application of gunshot wound principles to complex wound cases. Three entrances and three exits were identified. A seventh defect resulted from bullet passage. Finally, the wounds were sequenced.     

Confusing injury findings in a suicidal gunshot fired to the chest from a carbine with a sawed-off barrel

The stellate bullet entrance wound is one of the facultative features of a contact shot. For the formation of a star-shaped wound two factors are of special importance: first, an extensive bony support underlying the skin in the entrance region, and second, a strong propellant charge of the cartridge fired. Contact shots to the precordial region usually do not cause stellate entrance wounds, even if high-powered rifle ammunition is used. In the reported case, an injury pattern was observed that was not in line with normal findings and seemed confusing at first. Following a suicidal gunshot to the chest from a sawed-off carbine 98a (cal. 8 x 57 Js), a 4.5 cm wide, gaping bullet entrance wound with radiating tears was found. Instead of the usual pocket, the anterior thoracic wall showed a fist-sized area of destruction with extensive undermining of the subcutis. Not far from the entrance hole, a rib fragment had become displaced retrogradely thus perforating the skin from the inside out. The unusual pattern of findings could be explained by the fact that the barrel had been sawed off: as a result of this manipulation, a considerable part of the propellant charge had been converted outside the barrel, i.e. in the initial section of the bullet path.     

Unusual motor ability in gunshot injury of the heart caused by a shotgun

In a case of shotgun-injury of the heart with complete rupture of both ventricles and lesion of the aorta the victim was able to move a few metres in approximately six seconds. Despite other opinions ability to move or act can be maintained in cases of severest injuries of the heart caused by missiles with high energy.     

Multiple self-inflicted gunshot wounds to the head: report of a case and review of the literature

Multiple self-inflicted gunshot wounds to the head are rare and usually present a challenge to the pathologist and to the police in determining the manner of death. We report a case of two suicidal gunshot wounds to the head. The literature is reviewed, and the pertinent findings, including location of the wounds, location of the brain injuries, types of weapons used, and criteria important to determine the manner of death, are discussed.     

Suicidal contact gunshot wounds to the head with .38 Special Glaser Safety Slug ammunition

Glaser Safety Slug TM ammunition is a uniquely designed, essentially prefragmented ammunition. Tests performed by the U.S. Justice Department demonstrated that the ammunition possesses high kinetic energy, high relative incapacitation index (RII) and poses a very low risk to bystanders because of its total loss of kinetic energy in the target. Despite having been manufactured since 1974, no deaths from this ammunition have been previously reported. The authors herein describe the first three reported human deaths.     

Psychological factors in the determination of suicide in self-inflicted gunshot head wounds

Self-inflicted contact gunshot wounds to the head have usually been considered presumptive of suicide. This study evaluates whether sufficient psychological data are gathered in such cases to support a manner of death determination of suicide. We suggest that law enforcement agencies and coroner's departments do not fully explore the decedent's state of mind at the time of death. We studied the first 50 consecutive deaths in 1993 in a major metropolitan county due to self-inflicted gunshot wounds to the head. The sample consists primarily of unmarried, white males, with a median age of 35 years, who displayed psychiatric disturbance, primarily depression, before their death. Younger individuals were often under the influence of alcohol and/or drugs at the time of death. Stressors, such as the loss of a loved one, are common among young and middle-aged persons, while serious health problems are found among the majority of middle-aged and elderly individuals. Many of the findings of this study are consistent with the literature regarding individuals who commit suicide. Although data on many important psychological risk factors are missing in most cases, sufficient psychological material is gathered about the decedent's mental condition at the time of death to support a suicide determination.     

Self-inflicted penetrating head injury in a patient with manic-depressive disorder

A 32-year-old Caucasian male with a history of repeated self-injury drilled a hole in his skull using a power tool and subsequently introduced intracerebrally a binding wire from a sketch pad. An emergency craniotomy was performed around the site of cranial injury, and the foreign body was carefully extracted. The wire was located partially in the subdural space and partially in the right hemisphere of the brain. The patient made an excellent recovery and was referred to a psychiatrist for further treatment. This is a rare case of unusual and complex repetitive self-destructive behavior without apparent suicidal intent. The pertinent literature is reviewed and the surgical and psychiatric implications of such injuries are discussed.     

Bullet or bite--a contribution to the morphogenesis of gunshot dermal injury

Histopathologic studies of dermal dog bites revealed changes identical with those observed in distant gunshot skin entrance wounds and in a presternal skin stab wound made by a screwdriver. The similarity of the epithelial and collagen changes produced by these three totally different traumatizing, perforating agencies indicate that it is the bullet's penetrating and crushing power, and not its caloric content, that is responsible for the characteristic dermal collagen changes noted in these common injuries.     

Early post-mortem animal bites after suicidal gunshot wound to the head of a police dog handler]

A 41-year-old police officer committed suicide in his office by firing a contact shot to the left temple. When the body was found 12 hours later, the German shepherd dog the officer had been in charge of had caused considerable damage on the lower half of the face and the adjacent parts of the neck. The clothing of the suicide was undamaged. Blood traces in the shape of paws were found at the place of death. The wound margins of the postmortem animal injury were nicked and jagged by the canine teeth. The entrance and exit wounds were not affected by the soft tissue defect. The findings gathered are discussed in reference to the relevant literature.