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Deaths in a head-down position: a case report and review of the literature

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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 head-down 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.

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References

  1. Schäfer AT. Death in a head-down position. In: Tsokos M, editor. Forensic pathology reviews, vol. 3. Totowa, NJ: Humana Press; 2005. p. 137–54.

    Chapter  Google Scholar 

  2. Madea B. Death in a head-down position. Forensic Sci Int 1993;61(2–3):119–32.

    Article  PubMed  CAS  Google Scholar 

  3. Purdue B. An unusual accidental death from reverse suspension. Am J Forensic Med Pathol 1992;13(2):108–11.

    Article  PubMed  CAS  Google Scholar 

  4. Falk J, Riepert T, Iffland R, Rothschild MA. Tod infolge ungewöhnlicher Lage des Körpers – ein Beitrag zur Bedeutung des venösen Rückstroms zum Herzen. Arch Kriminol 2004;213(3–4):102–07.

    PubMed  Google Scholar 

  5. Marshall TK. Inverted suspension. Med Sci Law 1968;8(1):49–50.

    PubMed  CAS  Google Scholar 

  6. Yoshida K, Harada K, Sorimachi Y, Makisumi T. Death in head-down position: an autopsy report with reference to physiological mechanism. Nihon Hoigaku Zasshi 1995;49(1):33–6.

    PubMed  CAS  Google Scholar 

  7. Lawler W. Death by reverse suspension. Am J Forensic Med Pathol 1993;14(1):87–8.

    Article  PubMed  CAS  Google Scholar 

  8. Thiel I, Huckenbeck W. Der kalte tod and der Treppe. SeroNews 2003;8:32–34.

    Google Scholar 

  9. Spitz WU. Asphyxia. In: Spitz WU, Spitz DJ, editor. Spitz and Fisher’s medicolegal investigation of death: guidelines for the application of pathology to crime investigation. 4th edition. Springfield, IL: Charles C Thomas Publisher LTD; 2006. p. 783–845.

    Google Scholar 

  10. Cunningham DA, Petrella RJ, Paterson DH, Nichol PM. Comparison of cardiovascular response to passive tilt in young and elderly men. Can J Physiol Pharmacol 1988;66(11):1425–432.

    PubMed  CAS  Google Scholar 

  11. Chae EU, Suh YS. Hemodynamic responses to passive body tilts. Physiologist 1993;36(1 Suppl):S20–S21.

    PubMed  CAS  Google Scholar 

  12. Vijayalakshmi P, Madan M. Acute effect of 30 , 60  and 80  head-down tilt on blood pressure in young healthy human subjects. Indian J Physiol Pharmacol 2006;50(1):28–32.

    PubMed  CAS  Google Scholar 

  13. Nagaya K, Wada F, Nakamitsu S, Sagawa S, Shiraki K. Responses of the circulatory system and muscle sympathetic nerve activity to head-down tilt in humans. Am J Physiol 1995;268(5 Pt 2):R1289–R294.

    PubMed  CAS  Google Scholar 

  14. Bosone D, Ozturk V, Roatta S, Cavallini A, Tosi P, Micieli G. Cerebral haemodynamic response to acute intracranial hypertension induced by head-down tilt. Funct Neurol 2004;19(1):31–5.

    PubMed  Google Scholar 

  15. Jones AY, Dean E. Body position change and its effect on hemodynamic and metabolic status. Heart Lung 2004;33(5):281–90.

    Article  PubMed  Google Scholar 

  16. Deklunder G, Lecroart JL, Chammas E, Goullard L, Houdas Y. Intracardiac hemodynamics in man during short periods of head-down and head-up tilt. Aviat Space Environ Med 1993;64(1):43–9.

    PubMed  CAS  Google Scholar 

  17. Wilkins RW, Bradley SE, Friedland CK. The acute circulatory effects of the head-down position (negative G) in normal man, with a note on some measures designed to relieve cranial congestion in this position. J Clin Invest 1950;29:940–49.

    Article  PubMed  CAS  Google Scholar 

  18. Heckmann JG, Hilz MJ, Hagler H, Muck-Weymann M, Neundorfer B. Transcranial Doppler sonography during acute 80  head-down tilt (HDT) for the assessment of cerebral autoregulation in humans. Neurol Res 1999;21(5):457–62.

    PubMed  CAS  Google Scholar 

  19. Mengesha YA. Comparative study of haemodynamic responses to active and passive posture inducing head-ward pooling of blood in man. East Afr Med J 2001;78(4):212–15.

    PubMed  CAS  Google Scholar 

  20. Jauregui-Renaud K, Aw ST, Todd MJ, McGarvie LA, Halmagyi GM. Benign paroxysmal positional vertigo can interfere with the cardiac response to head-down tilt. Otol Neurotol 2005;26(3):484–88.

    Article  PubMed  Google Scholar 

  21. Naylor JM, Chow CM, McLean AS, Heard RC, Avolio A. Cardiovascular responses to short-term head-down positioning in healthy young and older adults. Physiother Res Int 2005;10(1):32–47.

    Article  PubMed  Google Scholar 

  22. Haennel RG, Teo KK, Snydmiller GD, Quinney HA, Kappagoda CT. Short-term cardiovascular adaptations to vertical head-down suspension. Arch Phys Med Rehabil 1988;69(5):352–57.

    PubMed  CAS  Google Scholar 

  23. Boone T. Blood pressure responses to different arm positions during vertical head-down ankle suspension. Aviat Space Environ Med 1991;62(4):328–30.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Laboratoire de sciences judiciaires et de médecine légale, Edifice Wilfrid-Derome, 1701, Parthenais street, 12th floor, H2K 3S7, Montreal, Quebec, Canada

    Anny Sauvageau, Anne Desjarlais & Stéphanie Racette

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  1. Anny Sauvageau
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  2. Anne Desjarlais
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  3. Stéphanie Racette
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Correspondence to Anny Sauvageau.

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Sauvageau, A., Desjarlais, A. & Racette, S. Deaths in a head-down position: a case report and review of the literature. Forensic Sci Med Pathol 4, 51–54 (2008). https://doi.org/10.1007/s12024-007-0031-4

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