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Suppression of the central nervous system: case report A 34-year-old man experienced suppression of the central nervous system following administration of diazepam and paroxetine [routes, dosages, indications and durations of treatments to reaction onset not stated]. The man, who was an alcoholic, was found dead in his apartment. A massive arterial blood pattern was observed at the scene. From the scene of inspection, it was initially suspected to be a criminal case. However, after going through the previous night’s video footage of a surveillance camera, it was observed that he repeatedly fell and hit his forehead on concrete footsteps while going home. Pre-autopsy CT scan analysis revealed no fractures or bleeding in the brain or any other body cavity. However, during the medicolegal autopsy, a 3cm long, lacerated wound was observed on the left forehead region. Later, reflection of the scalp showed a laceration with associated contusion and superficial temporal artery tear. Diminished lividity, pale skin, mucus membranes and internal organs, along with the presence of flamed-shaped subendocardial haemorrhages in the left ventricular outflow tract, were indicative of a haemorrhagic shock. Subsequently, urine, vitreous and blood samples were submitted for toxicological analysis, which showed the presence of alcohol [ethanol], diazepam and paroxetine. The blood alcohol content was 284 mg/100mL; however, the concentrations of diazepam and paroxetine were within therapeutic levels. It was therefore suspected that diazepam and paroxetine, along with alcohol, led to suppression of the central nervous system, which caused repeated falls, leading to blunt force trauma to his head. His scalp wound sections showed a laceration involving the epidermis and the upper dermis, with a laceration of the superficial temporal artery. Also, histological examination of the liver showed alcohol-related fatty changes. Considering all the above observations, it was concluded that the cause of death was exsanguination due to laceration of the superficial temporal artery, secondary to blunt force trauma to the head (accidental death) following repeated falls due to suppression of the central nervous system. Paroxetine, diazepam and alcohol were believed to have contributed to the same. Bodwal J, et al. Fatal bleeding from a laceration of superficial temporal artery: A rare case. Journal of forensic and legal medicine 75: 102054, Oct 2020. Available from: 803507116 URL: http://doi.org/10.1016/j.jflm.2020.102054

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Reactions 17 Oct 2020 No. 1826