Deaths in a head-down position: a case report and review of the literature
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CASE REPORT
Deaths in a head-down position: a case report and review of the literature Anny Sauvageau Æ Anne Desjarlais Æ Ste´phanie Racette
Accepted: 10 March 2007 / Published online: 16 August 2007 Ó Humana Press Inc. 2007
Abstract Deaths in a head-down position, mostly accidental events, are rare deaths in which a victim is found in an inverted body posture, with marked congestion of dependent body parts and no definite pathoanatomical cause of death. Such an exclusion diagnosis can only be put forward after elimination of other possible causes of death, following a scene investigation, medical record review, complete autopsy, and toxicological analysis. Particular attention should be taken not to confuse deaths by headdown position from the more usual positional asphyxia. We here report the case of an 82-year-old woman found stuck in the railings of the staircase leading to her house, her body freely suspended downward below the stairs. Death was finally attributed to a head-down position when correlating the autopsy findings with elements from the scene. Case reports of death by head-down position in the literature are reviewed. Furthermore, results from human experimental studies of head-down tilt are compiled. This systematic review allows an interesting insight into the physiopathology of those deaths, pointing more toward heart failure than to an asphyxial phenomenon per se. Keywords
Head-down Asphyxia Forensic pathology
Introduction Deaths in a head-down position are rare events, mostly accidental [1–3]. Several mechanisms have been proposed
A. Sauvageau (&) A. Desjarlais S. Racette Laboratoire de sciences judiciaires et de me´decine le´gale, Edifice Wilfrid-Derome, 1701, Parthenais street, 12th floor, H2K 3S7 Montreal, Quebec, Canada e-mail: [email protected]
to explain these deaths, but the exact physiopathology is still in debate [1–6]. Common features of deaths in a head-down position are: 1 2 3 4
finding of the body in a head-down or inverted position; marked ‘‘monstrous’’ congestion of head, neck, and other dependent parts of the body; congestion and edema of brain and lungs; and lack of a definite pathoanatomical cause of death [1].
Sometimes, lesions from self-rescuing attempts may also be noticed. We here report the unusual case of a woman found dead in a head-down position.
Case report A driver and his wife discovered the body of an 82-yearold woman lying outside her house. The victim had her right leg stuck in the railings of the staircase leading to her house, her body freely suspended downward below the stairs. She was dressed in a sweater and a skirt. She was also wearing a wind coat, a leather glove on her right hand and a pair of boots. The front door was unlocked. Inside the house, the table was set and a meat pie was still in the oven. Lights and television were on. According to the scene, the lady, who was living alone, dressed up to go out for only a few moments to take out the trash but fell on the icy stairs and got her right leg stuck in the railing. The vic
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