Excellent dirty death - thanks Meatpie!
A 65-year-old man was found lifeless in his apartment, laying in a peculiar head-down position. His head was on the floor and his neck was over-flexed, with his trunk flexed on his neck. Examination of the body showed intense violet lividity of the head, torso and limbs, according to the position of the body. Moreover, diffuse hemorrhagic spots on the shoulders, upper part of the back and upper arms, along with an intense arch-shaped purple area on the anterior neck were detected at external examination. Suspicions of neck injuries due to strangulation and death due to arose, but a thorough examination of circumstantial data and autopsy findings enabled a correct identification of cause and manner of death, and excluded strangulation and positional asphyxia as the cause of death. This case raises several issues on differential diagnosis and underlines the importance of a correct combined analysis of the findings provided by on-scene investigation and autopsy.
What is Simon's sign, and can we meet Simon?
We report on a remarkable case of positional asphyxia of an alcoholised young man after a fall down a staircase. On external examination, the body showed petechiae of the conjunctivae and oral mucosa, abrasions on the left zygomatic region and scratch marks, respectively. Neither broken fingernails, etc. nor signs of external violence against the neck were found. Autopsy revealed haemorrhages in the praevertebral cervical musculature and Simon’s sign. Haemorrhagic pulmonary edema and cerebral edema were observed; blood alcohol concentration: 2.60 g/l, urine alcohol concentration: 3.26 g/l. As cause of death, positional asphyxia after blunt head trauma has to be considered as well as lethal ethanol intoxication. To us, alcoholisation attributed to the fall and together with unconsciousness following blunt head trauma circumvented self-rescue efforts, and thererfore, aggravated the potentially lethal impact of positional restraint.