Asphyxiation from shoulder seat belts: an unusual motor vehicle injury

Two cases of accidental asphyxia caused by lap-shoulder seat belts are reported. Lethal neck injuries from shoulder seat belts are uncommon, and episodes of asphyxiation are even rarer. Positioning of the shoulder belt over the neck, short stature, and incapacitation from other injuries were predisposing factors to upper airway compromise in these cases.     

Accidental through and through penetrating injury to the neck

We present the case of a 24-year-old driver who died when a metal pole entered the front windshield, traveled through the victim's neck, and then exited via the back windshield. This case illustrated an unusual penetration injury and the importance of a thorough and complete death scene investigation.     

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.     

An unusual shotgun injury pattern produced by an intermediate target

Discharge of a shotgun with a shotgun casing in its muzzle as a "dust cover" produced a pattern of injuries suggestive of combined intermediate- and distant-range wounds.     

An unusual fatal injury due to tyre burst: a case report

A 20 year-old male driver of a heavy duty crane, employed in an industry located in an industrial area on the outskirts of Delhi was fatally injured while repositioning an ill-fitted locking rim of a crane tyre (Fig. 1). The inner tube of the crane tyre had accidentally burst, dislodging the loose iron-locking rim, which hit the individual with a great force resulting in multiple injuries. He died on his way to the hospital.     

Accidental head explosion: an unusual blast wave injury as a result of self-made fireworks

A 33-year old hobby pyrotechnician sustained a lethal craniofacial trauma secondary to a salute fireworks blast. He was examining a misfire of a self-constructed salute gun, when it detonated, causing an explosively rupture of his forehead, which led to his immediate death. An autopsy was performed to achieve knowledge of the injury and to be able to reconstruct the events that lead to it. The pressure effect of the explosion caused a shredded rupture of the forehead with a regional spread of brain tissue and small polygonal skull fragments up to 30m from the detonation site. Furthermore multiple cinderlike fragments of black powder were embedded in the skin of the face and the anterior aspect of the neck (s.c. blast tattoo). The complete destruction of the forehead in combination with the multiple blast tattooing suggested that the explosion detonated while he was leaning over the device.     

The 'break enter and die' syndrome may involve significant injury to major neck vessels

Death from incised wounds of major vessels may occur during illegal entry of premises. Wounds are often relatively unimpressive having been caused by thin shards of glass. Alcohol and/or drugs have often been taken that have impaired coordination and contributed to a failure to take appropriate action. A 37-year-old man slipped and fell while attempting to enter a house through a window that he had just broken. He was found dead surrounded by a large amount of blood. At autopsy, a single horizontal, deeply incised wound of the anterior neck was present with transection of the internal jugular veins bilaterally and the right common carotid artery. Toxicological studies were negative for alcohol and common drugs. Death was due to exsanguination and air embolism. This case demonstrates that the injuries sustained during such activities may be quite extensive and involve major neck vessels. Alcohol and drug intoxication are not necessarily involved.     

An unusual pattern of gunshot injury linking two homicides to the same assailant

This case report describes an unusual pattern of gunshot firing that proved useful in convicting one assailant of two murders. The assailant fired into the first victim, successively through the same entrance hole at contact range. This technique of firing twice through the same hole was also demonstrable on his second victim in the bare skull of the decomposed body. This unusual pattern noted in two homicides found two weeks apart, in concert with other circumstantial evidence, led to the successful conviction of the man for both murders.     

Planned complex suicide: an unusual case

Abstract:  We report an unusual case of planned complex suicide. The victim was a woman aged 67 years, who was found dead in her bath in a state of advanced putrefaction. A plugged-in hairdryer was submerged in the water and the electrical fuses in the room had short-circuited. A kitchen knife lay below the body of the victim, whose left forearm bore incisions suggestive of wrist-cutting. At autopsy, no sign suggesting electrocution could be observed because of the advanced state of putrefaction of the body. Toxicological analysis revealed massive ingestion of tianeptine (blood concentration 15.5 mg/L). Although the exact cause of death could not be determined because of the state of the corpse, meticulous examination of the scene and information obtained from the victim's relatives led to the conclusion of suicide.     

Multiple nails in the brain: an unusual suicidal attempt

We describe dangerous multiple self-inflicted brain-penetrating injuries caused by a nail gun device after a suicidal attempt for the first time in Iran. At the first forensic visit, we could not explain the manner of injuries. The authors reviewed the literature on the topics, and clinical presentation, radiographic findings, and forensic medical records are discussed.     

Dithranol: an unusual agent to produce artificial (false) bruise: a case report

Injuries are simulated by people for various reasons and may be labeled as "false/fictitious/forged." These may be self-inflicted or self-suffered. One such "injury" is an artificial/false bruise that may be produced by applying the juices of various irritant vegetable poisons. However, the present case is of an inmate of jail who used dithranol for producing 20 such artificial bruises on the back of his body. The purpose of such an act was to bring a charge of torture/beating against the jail officials.A good, thorough history taking and detailed and meticulous examination of the affected area, supplemented by relevant investigations and photography by a trained forensic expert, are a must to differentiate the "true" from the "false."     

Accidental hanging by a sweater: an unusual case

An accidental atypical hanging with the collar of a sweater is reported. A 67-year-old man was found dead in the sitting position with the collar of his sweater hanging off the brake handle of a motorcycle. Autopsy findings revealed a ligature mark on the surface of the neck; hemorrhages in the sternohyoid muscles; submucosal hemorrhages in the left greater horn of the hyoid bone; a large degree of submucosal petechial hemorrhages in the larynx, oral mucosa, and palpebral conjunctivae; and dark-red liquid blood with little clotting in the heart cavities. The alcohol levels in the blood and urine were 2.84 mg/ml and 3.52 mg/ml, respectively. It was concluded that the man had died from hanging by the sweater, and it was speculated that when he became inebriated, he might have lost consciousness and then fell with the collar of his sweater hanging from the brake handle of the motorcycle.     

Verapamil toxicity: an unusual case report and review of the literature

Verapamil blocks the rapid influx of calcium into the cardiac myocytes of the cardiac conduction system and smooth muscle of the vasculature, resulting in decreased myocardial contractility, prolonged conduction time, and vascular relaxation. A sustained-release form, verapamil SR (or ER), is available that contains higher levels of medication and requires only once-daily dosing. The majority of reported fatal cases of verapamil toxicity are due to massive, intentional overdoses. Herein, we present an unusual case of fatal verapamil SR toxicity in a 57-year-old female that resulted from accidental overdose of only 3 tablets (720 mg), as witnessed by the decedent's daughter. In spite of the low dose ingested, the postmortem cardiac blood verapamil level was clearly toxic (6000 ng/mL, or 6 mg/L). Her preexisting medical conditions included hypercholesterolemia, hypertension, iron deficiency anemia, diabetes mellitus, and associated mild chronic renal failure. Complicating factors, which likely include the decedent's preexisting renal and cardiac disease, and a review of the available literature will be discussed.     

An unusual autoerotic death: asphyxia with an abdominal ligature

A case of accidental death resulting from an autoerotic episode involving a high abdominal ligature is reported. Pathologic findings, physical evidence, and the psychological investigation are discussed.     

Complex suicide: an unusual case with six methods applied

Complex suicides (CSs) are committed by using more than one method. They account for 1.5-5% of all suicides. We present a case of CSs of a 44-year-old man, found dead in the vicinity of his car, in a deserted frozen field. Police investigation excluded homicide, and no medical data confirmed mental illnesses. Autopsy revealed wrist cuts, neck cuts, acid burns in the GI tract, multiple stab wounds to the head by a screwdriver, and several uncertain signs of hypothermia. Toxicology analysis (gas chromatography-mass spectrometry) confirmed ingestion of insecticide. We concluded that stab wounds to the head were the cause of death, while external hemorrhage and hypothermia were contributing factors. This is the first case of CSs reviewed in the literature where six suicide methods were applied. This particular case is interesting because the victim used a screwdriver as a tool for inflicting stab wounds to the head, which is a rare suicidal method.     

Fibromuscular dysplasia of the basilar artery: an unusual case with medico-legal implications

A 28-year-old male car driver was reported to suddenly loose the control over his vehicle, to hit the right and middle crash barrier, and to be unconscious as the car came to a halt in a position at right angles to the road. The car was hit in its left side by an automobile with high velocity, and the 28-year-old driver died. Examination of the brain revealed a massive isolated basal subarachnoid hemorrhage and a complete tearing of the basilar artery. A macroscopically detectable aneurysm was not found. However, histological examination of the large arteries at the base of the brain showed (i) fibromuscular dysplasia (FMD) mostly involving the basilar artery (ii) with a ruptured micro-aneurysm in its upper third part. The observations of the eye witnesses that the driver initially lost control over his car were judged in favour of the accused to be due to that rupture of the micro-aneurysm, while complete transverse tearing of the basilar artery occurred during the car crash due to hyperextension and rotation of his neck. Intracranial FMD is a rare cause in the differential diagnosis of isolated basal subarachnoid hemorrhage. The medico-legal implications of this entity are described in the presented case.