An unusual case of hypothermia and paradoxical undressing
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An unusual case of hypothermia and paradoxical undressing Fernando Pisani 1,2
&
Maria Nittis 1
Accepted: 8 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The case presented is that of an elderly woman found in her home, confused and with multiple body injuries. A forensic assessment was conducted based on the preliminary information that she was found with her pants pulled down to her ankles, an electrical cord laying across her neck, reported genital bruising, and that the back door of her home was open. Police initially treated the matter as a home invasion with physical and sexual assault but this was later considered incorrect. This case highlights that not all women found in a state of partial undress have been sexually assaulted, that initial information should be corroborated from its source, and the value of a multi-disciplinary approach when analyzing information to determine a possible sequence of events. Keywords Hypothermia . Paradoxical undressing . Sexual assault . Assault
Case report An 83 year-old female was found on the floor of her home in a Sydney suburb, having last been seen 1–2 days previously. She lived independently and was cognitively intact. The residence was in disarray with the back door open. She was confused and partially undressed, with her underpants around her ankles and with “bruising to the genitalia”. Figures 1 and 2 show the victim’s living room. Police and paramedics were called and the female was transported to hospital. Police identified two possible suspects: a known sex offender living locally and an unknown male who reportedly boasted of assaulting and robbing an elderly female.
Medical findings The female was hypothermic (34.3 °C), had a fluctuating level of consciousness, and multiple bruises to the trunk and limbs. She had mild acute kidney injury, troponin leak, elevated creatine kinase (CK), and elevated white cell count. Computed
* Fernando Pisani [email protected] 1
Forensic Medical Unit, Western Sydney Local Health District, PO Box 792, Seven Hills, Sydney NSW 2147, Australia
2
Emergency Department, Blacktown Hospital, Sydney, Australia
Tomography (CT) of the brain showed a parenchymal contusion with possible small subarachnoid component in the posterior left temporal lobe, and a small hematoma overlying the skull vertex, suggesting contrecoup injury. The local forensic unit was involved due to possible physical and sexual assault. Substitute consent was obtained, but initial assessment was limited due to competing medical priorities. Vulval and anal wipes were taken as an Early Evidence Kit. Further forensic assessment took place the next day in the Intensive Care Unit. Extensive bruising was noted to the limbs and back, with mixed injuries to the breasts (Figs. 3, 4 and 5). An external ano-genital examination showed no injuries. Internal examination was not possible. Genital swabs, skin swabs of the breasts and the right hand, and fingernail clippings were collected. A r
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