Abstract
We report the case of a 33-year-old man admitted to a psychiatric hospital because of paranoid schizophrenia. The man was found dead lying in his bed with the face pressed against a pillow and with elevated buttocks. The autopsy did not reveal a cause of death. The histological findings displayed the signs of the haemorrhagic–dysoric syndrome with acute emphysema; these findings are pathognomonic of obstructive asphyxia. The adverse effects of the neuroleptics demonstrated by the toxicological findings may have accelerated the loss of consciousness and facilitated the unusual position of the body. On the basis of the clinical history, the autopsy findings, the histological features and the toxicological results, asphyxia due to smothering was diagnosed as the cause of death.
Similar content being viewed by others
References
Bajanowski T, Vennemann M, Bohnert M, Rauch E, Brinkmann B, Mitchell EA, GeSID Group (2005) Unnatural causes of sudden unexpected deaths initially thought to be sudden infant death syndrome. Int J Legal Med 119:213–216
Banaschak S, Schmidt P, Madea B (2003) Smothering of children older than 1 year of age—diagnostic significance of morphological findings. Forensic Sci Int 134:163–168
Baselt RC (2008) Disposition of toxic drugs and chemicals in man, 8th edn. Biomedical Publications, Forster City, pp 297–343
Bohnert M, Große Perdekamp M, Pollak S (2005) Three subsequent infanticides covered up as SIDS. Int J Legal Med 119:31–34
Brinkmann B (1978) Vitale Reaktionen in der Lungenstrombahn bei Tod durch Strangulation. Z Rechtsmed 81:133–146
Brinkmann B (2004) Oronasale Okklusion. In: Brinkmann B, Madea B (eds) Handbuch gerichtliche Medizin. Springer, Berlin, p 784
Brinkmann B, Püschel K (1981) Die Lunge als Erfolgsorgan der Strangulationsagonie. Z Rechtsmed 86:175–194
Brinkmann B, Püschel K, Bause H-W, Doehm M (1981) Zur Pathophysiologie der Atmung und des Kreislaufs bei Tod durch obstruktive Asphyxie. Z Rechtsmed 87:103–116
Brinkmann B, Fechner G, Püschel K (1984) Identification of mechanical asphyxiation in cases of attempted masking of the homicide. Forensic Sci Int 26:235–245
Byard RW, Tsokos M (2005) Infant and early childhood asphyxial death. In: Tsokos M (ed) Forensic pathology reviews, vol 2. Humana Press, Totowa, pp 101–123
Edston E, Perkvist N (2008) Histiocytoid cardiomyopathy and ventricular non-compaction in a case of sudden death in a female infant. Int J Legal Med. doi:10.1007/s00414-008-0236-4
Fechner G, Püschel K, Burkhardt A, Brinkmann B (1984) Ultrastrukturpathologie der Lunge bei obstruktiver Asphyxie. Beitr Gerichtl Med 42:41–46
Flanagan RJ, Spencer EP, Morgan PE, Barnes TR, Dunk L (2005) Suspected clozapine poisoning in the UK/EIRE, 1992–2003. Forensic Sci Int 155:91–99
Hicks LJ, Scanlon MJ, Bostwick TC, Batten PJ (1990) Death by smothering and its investigation. Am J Forensic Med Pathol 11:291–293
Jang W, Gao C, Sun J, Bunai Y (2008) Sudden cardiac death caused by a primary intimal sarcoma of the left coronary artery. Int J Legal Med. doi:10.1007/s00414-008-0283-x
Kibayashi K, Nakao K, Shojo H (2008) Hypertermia combined with ethanol administration induces c-fos expression in the central amygdaloid nucleus of the mouse brain. A possible mechanism of heatstroke under the influence of ethanol intake. Int J Legal Med. doi:10.1007/s00414-008-0278-7
Matschke J, Püschel K, Glatzel M (2008) Ocular pathology in shaken baby syndrome and other forms of infantile non-accidental head injury. Int J Legal Med . doi:10.1007/s00414-008-0293-08
Möller HJ, Müller WE, Bandelow B (2001) Neuroleptika—Pharmakologischen Grundlagen, klinisches Wissen und therapeutisches Vorgehen. Wiss Verlagsges mbH, Stuttgart
Mueller B (1953) Gerichtliche Medizin. Springer, Berlin, p 417
Prokop O, Wabnitz R (1970) Vorkommen von Bindehautblutungen bei Lebenden und Toten, dargestellt in 10 Tabellen. Z Rechtsmed 67:249–257
Reddig S, Minnema AM, Tandon R (1993) Neuroleptic malignant syndrome and clozapine. Ann Clin Psychiatry 5:25–27
Schmidt P, Graß H, Madea B (1996) Child homicide in Cologne (1985–94). Forensic Sci Int 79:131–144
Schulz M, Schmoldt A (2003) Therapeutic and toxic blood concentrations of more than 800 drugs and other xenobiotics. Pharmazie 58:447–474
Wirth I, Strauch H, Schmeling A (2007) Latenzprobleme beim Ersticken unter weicher Bedeckung. Arch Kriminol 219:169–179
Author information
Authors and Affiliations
Corresponding author
Additional information
Dedicated to Prof. Dr. Dr. h.c. B. Brinkmann on the occasion of his 70th birthday.
Rights and permissions
About this article
Cite this article
Schmeling, A., Fracasso, T., Pragst, F. et al. Unassisted smothering in a pillow. Int J Legal Med 123, 517–519 (2009). https://doi.org/10.1007/s00414-009-0362-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00414-009-0362-7