Heroin dependence as a rare cause of symmetrical globus pallidus necrosis

Long-term survival after carbon monoxide intoxication has been accepted for a long time as pathognomonic for elective cerebral tissue damage, especially in cases of isolated symmetrical necrosis of the globus pallidus. The results of old bilateral necrosis in the globus pallidus are described in a case of an acute heroin death after long-term drug abuse. The evaluation of such cerebral changes is discussed as they have to be interpreted as hypoxic or oligemic tissue damage. The different causes of symmetrical necrosis of the globus pallidus that are relevant for legal medicine are compiled and discussed.     

Case report of pathologic and criminal self injury]

A case of morbid self-violence (Münchhausen Syndrome) leading to death and a case of criminal self-violence (cutaneous emphysema) are reported. The issue of such cases is discussed with regard to the consequences concerning judicial procedure of punishment and insurance.     

Homicides in Auckland, New Zealand. A 14-year study.

In the 14-year period from 1976 to 1989, there have been 174 homicide victims in the Auckland colonial area. Data accessed from autopsy and police reports show that victims of marital conflict, family dispute, and arguments developing between nonmarried couples made up the largest proportion of homicide cases. Stabbing and assault with a blunt weapon were the most common causes of death. The data also show that homicide is relatively uncommon in Auckland in comparison with other cities of similar size.     

Fire and suicide: a three-year study of self-immolation deaths.

Thirty-two self-immolation deaths by fire, representing about 1% of suicides, occurred in the province of Ontario (population 9 million), Canada, from 1986 through 1988. The victims, mostly male (male/female ratio, 26:6), were between 21 and 71 years old (mean age, 38 years). Although the scene of self-immolation was usually familiar to the deceased, some chose remote locations. Eleven were found dead in motor vehicles. An accelerant, usually gasoline, was used in most cases. Many of these individuals had, at some time, indicated their intent to commit suicide, a few by self-immolation, but only about half had a diagnosed psychiatric illness. Most of the victims had a reason to kill themselves, but the factors that motivated them to chose self-immolation by fire were uncertain. Fourteen individuals died in hospitals from severe burn complications. The remainder were found dead at the scene. The postmortem findings of soot in the airway and elevated carbon monoxide in the blood of most of these victims [the carboxyhemoglobin (COHb) concentration was in one case less than 10%, in ten cases greater than or equal to 10 to 50%, and in seven cases greater than 50%] were helpful in determining that the individuals were not only alive at the time of the fire but also that a significant number died from smoke inhalation and carbon monoxide poisoning. The highest levels of carbon monoxide were observed in victims discovered in motor vehicles.     

Mental health professionals in forensic arenas

The authors discuss a variety of forensic matters using cases in which they have been involved as experts. Pertinent issues are illustrated in cases in which the offender is charged with homicide. The need for a comprehensive evaluation, the importance of corroboration of the offender's statements, and the value of preparing a thorough report are discussed.