ABSTRACT
In majority of deaths from asphyxiation that affect the cerebral blood flow, compression occurs at the neck. Compressive asphyxia caused by a heavy weight is usually the result of an accident. The authors used the Korean national police agency's scientific crime analysis system to identify two cases of suicide by strangulation which were not otherwise specified, wherein asphyxiation occurred from an object pressing on the neck. In the first case, a man in his 50s died after the compression of his neck with a barbell shaft using a bench press. In the second case, a man in his 80s died due to compression from the side bar of a single bed that pressed on his neck. As far as the authors know, there have been no reported cases of suicide in forensic literature that occurred due to compression from an object such as a barbell shaft of a bench press or a side bar of a bed. Upon classifying the types of asphyxiation, accurate statistics should be prepared and researched, with accurate understanding and classification of the terms therein. Each case in the present report is discussed along with a brief literature review.
ABSTRACT
We present an autopsy case of a 19-year-old man with a history of epilepsy whose unwitnessed sudden death occurred unexpectedly in the night. About 4 years before death, he was diagnosed with unilateral optic neuritis (ON). Demyelinating disease was suspected, but he was lost to follow up after the recovery. Six months before death, he received a second dose of mRNA coronavirus disease 2019 (COVID-19) vaccine. Three months before death, he experienced epileptic seizures for the first time. Seventeen days before death, he was infected with COVID-19, which showed self-limited course under home isolation. Several days before death, he complained of seizures again at night. Autopsy revealed multifocal gray-tan discoloration in the cerebrum. Histologically, the lesions consisted of active and inactive demyelinated plaques in the perivenous area of the white matter. Perivascular lymphocytic infiltration and microglial cell proliferation were observed in both white matter and cortex. The other major organs including heart and lung were unremarkable. Based on the antemortem history and postmortem findings, the cause of death was determined to be multiple sclerosis with suspected exacerbation. The direct or indirect involvement of cortex and deep gray matter by exacerbated multiple sclerosis may explain the occurrence of seizures. Considering the absence of other structural abnormalities except the inflammatory demyelination of the cerebrum, fatal arrhythmia or laryngospasm in the terminal epileptic seizure may explain his sudden unexpected death in the benign circumstances. In this case, the onset of seizure was preceded by COVID-19 vaccination, and the exacerbation of seizure was preceded by COVID-19 infection, respectively. Literature reporting first manifestation or relapse of multiple sclerosis temporally associated with COVID-19 vaccination or infection are reviewed.
ABSTRACT
Dry ice is a solid form of carbon dioxide and is commonly used in everyday life to keep food or medicine cold. In South Korea, there have been rare cases of carbon dioxide asphyxiation and poisoning from dry ice, though there have been no reports of its use in suicide. In the first case, a man was found lying down dead and left a large amount of dry ice in his room. In the second case, a man died by tying a belt around his neck after placing a plastic bag filled with dry ice over his head. The third death was by placing a large amount of dry ice in a large rubber basin in his room and filling it with water. Dry ice itself is mostly harmless, but if it is not handled carefully in a confined space, it can cause accidents due to accidental oxygen deprivation. Its easy availability in everyday life also means it is likely to be misused for suicidal purposes. Investigators should consider the potential for asphyxiation or poisoning incidents if they discover dry ice or its packaging at the forensic scene.
ABSTRACT
Although most cerebral aneurysms are considered as acquired degenerative lesions, diverse anatomical variations in the circle of Willis have been encountered, some of which may play an important role in lesion hemodynamics and pathogenesis. The coalescence of the small vascular plexus to form the anterior communicating artery at the 6-7-week embryological stage may lead to developmental variations, such as fenestration and duplication. Herein, we report a rare anatomical variant of the anterior communicating artery that was concomitantly identified with a ruptured aneurysm. Both the right and left anterior cerebral arteries were connected by three anterior communicating arteries. A vertical segmental artery was present and connected the two anterior communicating arteries, forming an H-shape or plexiform structure. Furthermore, a 0.6×0.4 cm-sized saccular aneurysm with antero-inferior projection was present in the middle anterior communicating artery. The combination of triplication and H-shape in the present case was compared to previously reported anatomical variants.
ABSTRACT
Hanging is the most common form of suicide, but the use of a single ligature in a suicide pact is very rare. The authors identified three cases of double hanging through the National Police Agency's Scientific Crime Analysis System over 11 years in Korea, from 2008 to 2018. Of the six deaths, all but one were suicides; one was a victim of murder (suicide after murder). A couple was found hanging by a single ligature over a beam, wherein a man hanged himself using the weight of the woman he had strangled to death. A mother and her daughter used a chest of drawers as a fulcrum off which they hanged themselves, with one on each side of the drawers, using a single rope. Two lovers were found sitting at each end of the rope, using a single ligature, with a tree branch as an abutment. Each of these cases is discussed and reported along with a brief literature review. In a double hanging case, investigators should be cautious in determining the manner of death by distinguishing between a suicide pact from a homicide-suicide.
ABSTRACT
We present a rare case of spindle cell oncocytoma (SCO) of the sella turcica with malignant histologic features and rapid progression. A 42-year-old woman experienced bilateral blurred vision and was preoperatively misdiagnosed as having a pituitary macroadenoma on magnetic resonance imaging. After surgery, SCO was diagnosed by the histopathologic features of interlacing fascicles of spindle tumor cells with finely granular, eosinophilic cytoplasm. Focal anaplastic changes and necrosis were present. Immunohistochemically, the tumor cells were positive for vimentin, epithelial membrane antigen, S-100, galectin-3, and thyroid transcription factor 1. Four months later, the tumor had progressed, and second surgery with adjuvant radiotherapy was performed; the patients remains under observation. In this report, we proposed distinctive radiologic features for differential diagnosis between SCO and other pituitary tumors.
ABSTRACT
We present autopsy findings of a 22-year-old man who developed chest pain 5 days after the first dose of the BNT162b2 mRNA vaccine and died 7 hours later. Histological examination of the heart revealed isolated atrial myocarditis, with neutrophil and histiocyte predominance.Immunohistochemical C4d staining revealed scattered single-cell necrosis of myocytes which was not accompanied by inflammatory infiltrates. Extensive contraction band necrosis was observed in the atria and ventricles. There was no evidence of microthrombosis or infection in the heart and other organs. The primary cause of death was determined to be myocarditis, causally-associated with the BNT162b2 vaccine.
ABSTRACT
We present a rare case of spindle cell oncocytoma (SCO) of the sella turcica with malignant histologic features and rapid progression. A 42-year-old woman experienced bilateral blurred vision and was preoperatively misdiagnosed as having a pituitary macroadenoma on magnetic resonance imaging. After surgery, SCO was diagnosed by the histopathologic features of interlacing fascicles of spindle tumor cells with finely granular, eosinophilic cytoplasm. Focal anaplastic changes and necrosis were present. Immunohistochemically, the tumor cells were positive for vimentin, epithelial membrane antigen, S-100, galectin-3, and thyroid transcription factor 1. Four months later, the tumor had progressed, and second surgery with adjuvant radiotherapy was performed; the patients remains under observation. In this report, we proposed distinctive radiologic features for differential diagnosis between SCO and other pituitary tumors.
ABSTRACT
We present autopsy findings of a 22-year-old man who developed chest pain 5 days after the first dose of the BNT162b2 mRNA vaccine and died 7 hours later. Histological examination of the heart revealed isolated atrial myocarditis, with neutrophil and histiocyte predominance.Immunohistochemical C4d staining revealed scattered single-cell necrosis of myocytes which was not accompanied by inflammatory infiltrates. Extensive contraction band necrosis was observed in the atria and ventricles. There was no evidence of microthrombosis or infection in the heart and other organs. The primary cause of death was determined to be myocarditis, causally-associated with the BNT162b2 vaccine.
ABSTRACT
Hypoplastic coronary artery disease (HCAD) is a rare congenital abnormality characterized by underdevelopment of one or more major branches of the coronary arteries, which may lead to myocardial infarction and sudden death. We report a case of HCAD that was incidentally detected during autopsy in a 25-year-old male soldier who died during underwater escape training. On macroscopic examination, the right coronary artery measured 1 mm in diameter, which was significantly smaller than that of other coronary arteries. We observed no anomalies in addition to HCAD. Death was attributed to drowning, which was consistent with autopsy findings and the circumstances of death. Although extremely rare, if sudden cardiac death is suspected in children and young adults, it must be confirmed through careful evaluation.
ABSTRACT
An air blow gun is one of the most common pneumatic tools found at industrial sites and entrances of mountain trails in South Korea. It is used for spraying high-pressure air to dust off surfaces and clothes, and to inject air into tubes. There have been many reported cases of injuries and deaths associated with air blow guns. The victim died by placing the nozzle of an air blow gun, installed on an outdoor sports field, into her nose, and pulling the trigger. An autopsy ascribed her death to pneumothorax. Numerous accidents associated with air blow guns have been reported in the media. However, the use of an air blow gun has not been the subject of a suicide case study in forensic literature. To our knowledge, this is the first case report on suicide using an air blow gun. Stronger public safety warnings stressing the potentially fatal outcomes from careless usage of air blow guns are required.
ABSTRACT
One of the most common methods of suicide is hanging, and suicide by ligature strangulation is quite rare. Vehicles have a confined space, making them an unusual place for committing suicide by hanging or ligature strangulation, because they are more typically the location of suicide by carbon monoxide intoxication by briquette or drug intoxication. Here, we present three cases of unusual suicide by ligature strangulation, discuss the mechanism of asphyxia in each case, and review the literature. In case 1, the victim used a backpack to perform reverse hanging by wrapping the shoulder strap of the backpack around his neck and then tossing the backpack behind the backrest of the driver's seat. In case 2, the victim did not use the internal structures of the vehicle, but pulled down on a ligature wrapped around both his knees and neck. In case 3, the victim hanged himself using a package line fixed to the roof handle grab of the back passenger seat.
ABSTRACT
Gastromalacia refers to the postmortem acute autolytic erosion of the gastric wall. It should be distinguished from gastric perforations caused by antemortem injuries or other pathologic processes, such as ulcer perforations. It appears as a slimy brownish-black perforation of the gastric wall. The diagnosis is based on the presence of a typical macroscopic perforation in the fundic portion of the stomach, lack of vital reactions in the adjacent organs, and lack of clinical or autopsy evidence of trauma. Here, we report two cases of gastromalacia: one in a 53-year-old woman who died from severe head injury and another in a 2-year-old child who died from neglect by his father. Gastromalacia is a welldefined phenomenon, but due to its rarity in the practical work, it could be misdiagnosed as other causes of gastric perforation.
ABSTRACT
One of the most common methods of suicide is hanging, and suicide by ligature strangulation is quite rare. Vehicles have a confined space, making them an unusual place for committing suicide by hanging or ligature strangulation, because they are more typically the location of suicide by carbon monoxide intoxication by briquette or drug intoxication. Here, we present three cases of unusual suicide by ligature strangulation, discuss the mechanism of asphyxia in each case, and review the literature. In case 1, the victim used a backpack to perform reverse hanging by wrapping the shoulder strap of the backpack around his neck and then tossing the backpack behind the backrest of the driver's seat. In case 2, the victim did not use the internal structures of the vehicle, but pulled down on a ligature wrapped around both his knees and neck. In case 3, the victim hanged himself using a package line fixed to the roof handle grab of the back passenger seat.
ABSTRACT
Gastromalacia refers to the postmortem acute autolytic erosion of the gastric wall. It should be distinguished from gastric perforations caused by antemortem injuries or other pathologic processes, such as ulcer perforations. It appears as a slimy brownish-black perforation of the gastric wall. The diagnosis is based on the presence of a typical macroscopic perforation in the fundic portion of the stomach, lack of vital reactions in the adjacent organs, and lack of clinical or autopsy evidence of trauma. Here, we report two cases of gastromalacia: one in a 53-year-old woman who died from severe head injury and another in a 2-year-old child who died from neglect by his father. Gastromalacia is a welldefined phenomenon, but due to its rarity in the practical work, it could be misdiagnosed as other causes of gastric perforation.
ABSTRACT
Tanycytic ependymoma is a rare variant of ependymoma that commonly affects the cervical and thoracic spinal cord. It usually arises as intramedullary lesions, and extramedullary cases are extremely rare. We report a case of a 44-year-old woman who was diagnosed with tanycytic ependymoma in her lumbar spine at level 2-3. The tumor mass developed in an intradural extramedullary location. Histopathologically, tanycytic ependymoma can be misdiagnosed as schwannoma or pilocytic astrocytoma. Immunohistochemical findings such as strong positivity for glial fibrillary acidic protein, perinuclear dot-like positive patterns for epithelial membrane antigen, and focal positivity for S-100 are helpful in diagnosing tanycytic ependymoma. It is important to be aware of this rare tumor to ensure appropriate patient management and accurate prognosis.
ABSTRACT
One of the most common methods of suicide is hanging, and suicide by ligature strangulation is quite rare. Vehicles have a confined space, making them an unusual place for committing suicide by hanging or ligature strangulation, because they are more typically the location of suicide by carbon monoxide intoxication by briquette or drug intoxication. Here, we present three cases of unusual suicide by ligature strangulation, discuss the mechanism of asphyxia in each case, and review the literature. In case 1, the victim used a backpack to perform reverse hanging by wrapping the shoulder strap of the backpack around his neck and then tossing the backpack behind the backrest of the driver's seat. In case 2, the victim did not use the internal structures of the vehicle, but pulled down on a ligature wrapped around both his knees and neck. In case 3, the victim hanged himself using a package line fixed to the roof handle grab of the back passenger seat.
ABSTRACT
Gastromalacia refers to the postmortem acute autolytic erosion of the gastric wall. It should be distinguished from gastric perforations caused by antemortem injuries or other pathologic processes, such as ulcer perforations. It appears as a slimy brownish-black perforation of the gastric wall. The diagnosis is based on the presence of a typical macroscopic perforation in the fundic portion of the stomach, lack of vital reactions in the adjacent organs, and lack of clinical or autopsy evidence of trauma. Here, we report two cases of gastromalacia: one in a 53-year-old woman who died from severe head injury and another in a 2-year-old child who died from neglect by his father. Gastromalacia is a welldefined phenomenon, but due to its rarity in the practical work, it could be misdiagnosed as other causes of gastric perforation.
ABSTRACT
The authors investigated the cases of electrocution suicides in South Korea from 2008 to 2018. Out of 151,419 suicides during this 11-year period, suicide by electrocution was extremely rare. Only nine victims were recorded in eight cases, with one case involving a married couple. The majority of the victims were men (89%), and only one case involved a woman (11%). The mean age of the victims was 55 years, and ranged from 38 to 74 years. In all cases, the suicides occurred in the home, and low-voltage electricity was used. Two of the nine victims (22%) had an occupation related with electrical knowledge. Mental illness, such as depression and schizophrenia, was found in two cases (22%). An autopsy was not performed in all cases.
ABSTRACT
Complex suicide refers to a type of suicide that leads to death using two or more methods. We report three cases of unique and rare examples of complex suicide, with the plan of the second and/or third method working simultaneously if the first suicidal attempt had failed. In the first case, the victim used three methods of asphyxia: hanging by a safety belt, plastic bag suffocation, and self-ligature strangulation by stretching rubber bands within the vehicle. In the second case, the victim hanged himself with electrocution by attaching electrical leads to the right side of his head. In the third case, the victim with the intention of drowning jumped 20 m above the water surface on the bridge by tying metal chains to the bridge rail and self-immolation by gasoline. Planned complex suicide involves more successful methods to commit suicide and may conversely be camouflaged as suicide in murder case.
