Intoxicación suicida por paracetamol / Suicidal poisoning with paracetamol

La intoxicación por paracetamol es un hecho verdaderamente infrecuente, debido sobre todo al elevado rango terapéutico que posee. Los efectos letales de su ingestión a menudo son el resultado de las complicaciones que originan, aunque por efecto directo del fármaco (intoxicación aguda) se producen tanto en suicidios como a causa de sobredosis en búsqueda de analgesia (intoxicación medicamentosa accidental). El presente artículo expone el caso de una mujer joven con antecedentes psiquiátricos, que fallece tras la ingestión de una elevada dosis de esta substancia. La ausencia de información previa, la rareza del método elegido y la inespecificidad del cuadro clínico, complicaron inicialmente la resolución del caso. Los hallazgos necrópsicos, así como el conocimiento de sus antecedentes psiquiátricos y la ulterior investigación policial, fueron claves para aclarar el origen y la etiología médico legal de la intoxicación (AU)

Delayed presentation of carotid dissection, cerebral ischemia, and infarction following blunt trauma: two cases.

Carotid artery dissection followed by cerebral infarction as a result of blunt trauma can occur in a number of forensically relevant situations. We describe two such cases. In the first case, a 19-year-old female was involved in a road traffic accident, when her car crashed into the rear of another car. Initially, the young woman presented a minor head injury without loss of consciousness and minor bruising to the left side of the neck. After 48 h, she had developed confusion, speech difficulties, right facial nerve paralysis, and right hemiplegia. CT scan and carotid angiography showed cerebral ischemia with infarction in the territory of the middle left cerebral artery and complete dissection of the left carotid artery. In the second case, a 33-year-old male with depression attempted to hang himself. The rope gave way and he fell down. He had also taken a paracetamol, and a non-steroidal anti-inflammatory drug overdose. He did not lose consciousness but appeared withdrawn and depressed. Approximately 6 h later, his conscious state deteriorated. A CT scan revealed thrombosis of the left internal carotid artery, extending to the middle cerebral artery. The patient died. Both cases reinforce the need for full neurological assessment and review of any individual subject to blunt trauma to the neck, whether accidental or deliberate or where the history is incomplete. In the forensic setting, in particular, RTAs, suspension by the neck, strangulation, and garotting are all instances when examination and assessment must be thorough--and clear advice given--in the absence of any immediate signs or symptoms--that any new symptoms or signs require immediate and thorough neurological investigation. There should be low threshold for prolonged neurological observation or further neurovascular investigations such as ultrasound, CT or MRI scan or angiography, to minimize the risk of developing potentially fatal or incapacitating sequelae.