Edwin Ehrlich

Postmortem radiological investigation of bridging vein ruptures

In the usual method of brain removal in forensic autopsies, the upper bridging veins were invariably torn. There are several types of head injuries, in which ruptures of these vessels are the predominant intracranial injury. For the past 5 years we have investigated nearly all cases of lethal head injuries by a simple X-ray method (axial X-ray after instillation of contrast material into the superior sagittal sinus). The evaluation of the 350 X-rays which were available until today can be summarized by the following statements. (a) Anatomy of the parasagittal bridging veins: regarding the numbers and diameters of the veins, we can separate cases with many bridging veins of small diameter from a group with few veins of a large diameter. (b) Causes of injury and direction of impact: bridging vein ruptures resulted more often from frontal than from occipital, parietal and lateral impacts and occurred in traffic accidents in the majority of our cases.

Lethal pedestrian - Passenger car collisions in Berlin Changed injury patterns in two different time intervals

To expand the passive safety of automobiles protecting traffic participants technological innovations were done in the last decades. Objective of our retrospective analysis was to examine if these technical modifications led to a clearly changed pattern of injuries of pedestrians whose death was caused by the accidents. Another reduction concerns the exclusion of injured car passengers--only pedestrians walking or standing at the moment of collision were included. We selected time intervals 1975-1985 and 1991-2004 (=years of construction of the involved passenger cars). The cars were classified depending on their frontal construction in types as presented by Schindler et al. [Schindler V, Kühn M, Weber S, Siegler H, Heinrich T. Verletzungsmechanismen und Wirkabschätzungen der Fahrzegfrontgestaltung bei Pkw-Fussgänger-Kollisionen. Abschlussbericht im Auftrag der Deutschen Versicherungswirtschaft e.V. TU-Berlin Fachgebiet Kraftfahrzeuge (GDV) 2004:36-40]. In both periods more than 90% of all cars were from the usual types small/medium/large class. Hundred and thirty-four autopsy records of such cases from Department of Forensic Medicine (Charité Berlin) data were analysed. The data included technical information of the accidents and vehicles and the external and internal injuries of the victims. The comparison of the two periods showed a decrease of serious head injuries and femoral fractures but an increase of chest-, abdominal and pelvic injuries. This situation could be explained by an increased occurrence of soft-face-constructions and changed front design of modern passenger cars, resulting in a favourable effects concerning head impact to the car during accident. Otherwise the same kinetic energy was transferred to the (complete) victim - but because of a displacement of main focus of impact the pattern of injuries modified (went distally).

Neck Injuries Caused by Being Run Over by a Motor Vehicle

We report a homicide involving the use of a motor vehicle and simulating a traffic accident. This observation was the reason for a retrospective analysis of neck injuries in victims of traffic accidents, in which a person has been run over (RO) by a motor vehicle. The autopsy material of two institutes from 1990-1996 was used. The following findings were obtained in 63 victims: laryngohyoid fractures (LH-fx): 10 cases (16%) with a clear difference between the institutes (22% versus 7%). This resulted from examination with special regard to such injuries in many cases at one of the institutes, whereas only autopsy reports were taken retrospectively from the other institute. Five of these cases had suffered only minor LH-fx (as seen frequently in strangulation), although extensive run over (RO) injuries of the other cervical tissues were present. All LH-fx were caused by direct compression of the neck; in eight of the cases they were combined with mandibular fractures. Petechial hemorrhages (petH) at the eye lids/conjunctivae were seen in 19 cases (30%); 16 of these were related to thorax RO injuries, three to abdominal RO only. Four cases involved LH-fx, petH as well as cervical skin lesions and additional cervical soft tissue hemorrhages. Interpretation can be extremely difficult with this combination of findings if the character of the event cannot be established as accidental beyond doubt on the basis of the circumstances.

Fatal spontaneous subdural bleeding due to neonatal giant cell hepatitis: a rare differential diagnosis of shaken baby syndrome

A 7-week-old girl showed vomiting after feeding, facial pallor, loss of muscle tone and respiratory depression. An emergency doctor performed successful resuscitation and after arrival in hospital, cranial ultrasound showed left-sided subdural hemorrhage, cerebral edema with a shift of the midline, and a decrease in cerebral perfusion. Ophthalmologic examination showed retinal hemorrhage. In view of this, the doctors suspected shaken baby syndrome and approached the parents with their suspicions, but they denied any shaking or trauma. Despite surgery for the subdural hemorrhage the girl died a few hours later with a severe coagulopathy. Autopsy verified subdural hemorrhage, cerebral edema and retinal hemorrhage, but also revealed intact bridging veins and a lack of optic nerve sheath hemorrhage, therefore shaken baby syndrome could not be proven by autopsy. Histological examination showed severe neonatal giant cell hepatitis as the cause of the severe coagulopathy and the associated spontaneous subdural bleeding. Neonatal giant cell hepatitis may be responsible for unexpected deaths in infancy and, although rarely associated with subdural bleeding, must be considered as a potential differential diagnosis of shaken baby syndrome.

An extreme case of necrophilia.

This report presents the case of a young man legally convicted twice on a charge of defiling the dead. All necrophilic acts were committed over a period of around 15 years. The examination results revealed a purely female-fixated necrophilia. In three cases, the perpetrator skinned the trunk of the corpses, placed the skin on his naked body and stimulated himself sexually. In several cases, he also used burial clothes that he had removed from the coffins and kept at home. The perpetrator had a long record of psychiatric treatment for his sexual inclination.

Atypical gunshot entry wound.

A 21-year-old man shot himself in the chest during a suicide attempt. He had been sitting in a bistro with his friends when his girlfriend broke up with him by phone. He became intoxicated, said goodbye to his friends and went to the restrooms in the back of the bistro. After a while, he tumbled back out into the dining area and told his friends that he had shot himself. Then he collapsed. Resuscitation measures were initially successful and he was taken to hospital, however, he did not regain consciousness and died very soon after admission. An automatic pistol (Fabrique Nationale d’Armes de Guerre Herstal, Belgium; model: 1922; Browning’s patent depose), the projectile (cal. 7.56), and smaller parts of the gun were later found in the restrooms. Medicolegal autopsy showed that the man had shot himself through his clothes into the thorax. Upon firing the automatic pistol, the recoil spring from within the firearm had been hit by the bullet and was pulled through the entry point into the thoracic cavity, where it was protruding from the deceased’s chest (Fig. 1). The recoil spring had pierced the lung tissue, which was wrapped around the coiled end (Fig. 2). The projectile had destroyed the 3rd left rib, pierced the pericardium, and then opened the left ventricle (Fig. 3). In addition, the bullet had travelled through the left side of the diaphragm, the fundus of the stomach, the upper pole of the spleen, and again through the diaphragm into the left chest cavity where it had pierced the upper and lower lobe of the left lung (Fig. 4). The projectile then became lodged in the left latissimus dorsi muscle, where it was discovered at autopsy. 1.560 ml of blood was extracted from the left thoracic cavity, and 450 ml of bloody fluid was extracted from the right thoracic cavity. The recoil spring was remarkably twisted when it was removed from the chest. The tip of the projectile showed indentations matching the front end of the spring that was protruding from the deceased’s chest, thus demonstrating that the bullet had caught the spring as it was fired from the barrel (Fig. 5). The cause of death was a gunshot wound to the thorax. The manner of death was suicide.

A series of hospital homicides

Patient deaths in hospitals due to medical staff are very rare. In the autumn of 2006, preliminary proceedings were initiated against a nurse on account of an overdose of medication leading to death, administered during her care of the patient. In the course of these proceedings, exhibits relating to the deaths of a total of 13 patients who had died due to chemical-toxicological causes were reviewed. Nine of them were exhumed. On average, death had occurred 22 months prior to exhumation (range of 1-34 months). The average age of the deceased was 76 years (range of 65-92 years). In five of the cases, analysis results and an evaluation of the medical records confirmed that a final, undocumented dose of sodium nitroprusside or midazolam was administered. After administration of sodium nitroprusside, the active agent rapidly releases nitrogen monoxide, itself undetectable. Another indicator that can be detected, however, is the cyanide that is also released. In one of the exhumed patients, cyanide could still be detected 18 months after death. The nurse stated that her motive was sympathy towards seriously ill patients. She was sentenced res judicata to life imprisonment on five counts of causing the death of a patient.

Medical studies and training duration for forensic pathologists in Germany

This article gives a short overview of medical education in Germany. The legal basis and organization of the medical studies program as well as the course in forensic medicine and the training duration for forensic pathologists are described.