A 26-year-old young man died shortly after he had suffered craniocerebral impalement from a metal chair leg during an affray at an airport bar. At autopsy a 25 mm diameter circular wound was present in the left parietal region with protruding brain tissue. Death was due to craniocerebral trauma from a penetrating injury to the head. Examination of the chair used in the assault showed a metal chair with smeared blood on the front right leg that matched the blood group of the decedent. The fatal wound had been inflicted by the assailant with the victim leaning forward while kneeling on the floor. The assault had produced an unusual circular patterned defect in the left parietal bone with dimensions corresponding to the chair leg. The location of the defect and the use of a chair leg were two very unusual features in this homicide.
A 26-year-old young man was involved in an affray at an airport bar during which time he was hit in the head with the leg of a metal chair. He rapidly lost consciousness and was declared dead on arrival at hospital.
At autopsy the major findings were limited to the head where shaving of the hair revealed a 25 mm diameter circular wound in the left parietal region (Fig. 1). Brain tissue was protruding from the wound. Dissection revealed an underlying circular punched out defect of the parietal bone also measuring 25 mm in diameter with surrounding subgaleal hematoma formation (Fig. 2). There was no shelving. Diffuse subarachnoid hemorrhage was present mainly over the surface of the left cerebral hemisphere. The wound passed through the dura and downwards and forwards in a parasagittal plane through brain parenchyma to a depth of 50 mm within the parietal lobe. The defect was surrounded by focal areas of intra-parenchymal hemorrhage. Death was due to craniocerebral trauma from a penetrating injury to the head.
Examination of the chair that was allegedly used in the assault showed a chrome metal chair (Fig. 3) weighing approximately 12 kg with four legs having diameters of 25 mm (Fig. 4), which corresponded exactly to the shape and size of the head wound. The front right chair leg had smears of blood that matched the blood group of the decedent. The fatal wound had been inflicted by the assailant with the victim leaning forward while kneeling on the floor.
Homicidal head injuries are most commonly the result of blunt craniocerebral trauma that occur when a head is either impacted against a solid surface such as the ground or a floor, or is struck with a blunt object. External manifestations include bruising and irregular lacerations with underlying injuries including skull fractures, intracranial hemorrhage and cerebral lacerations and contusions .
Inflicted penetrating injuries may also be lethal and most often involve projectiles from firearms, or more rarely nail guns . Uncommonly stab wounds may occur from sharp objects such as knives, swords or screwdrivers, however these are usually limited to areas such as the orbital plates, nasal region or squamous temporal bones where the skull is at its thinnest [3,4,5,6]. These injuries are characterized by weapons having a small impact area and travelling at low velocity . The mortality rate from intracranial stab wounds is as high as 17% due to uncontrolled hemorrhage . Bones such as the occipital, anterior frontal and parietal are, however, usually of sufficient thickness and density in adults to thwart penetration, with an average thickness in an adult of 15 mm in the occipital bone, 8 mm in the frontal, and 7 mm in the parietal . Considerable individual variation does, however, exist and underlying conditions such as Paget disease and hyperostosis frontalis may considerably increase skull thickness and density.
Non-missile penetrating injuries of the brain account for only about 0.4% of all head injuries . Significant findings include cerebral lacerations and hemorrhage, as in the reported case, with a risk of subsequent sepsis in survivors potentially leading to later onset meningitis and/or brain abscesses . Later hemorrhage from traumatic aneurysm rupture may also be a cause of delayed death . Unusual objects penetrating the skull have included scissors, knitting needles, crochet hooks, a toilet brush handle, an antler, pitchforks, glass, car antennas, crowbars, umbrella ribs and crossbow bolts [3, 7, 12, 13]. The ability of a foreign object to enter the head is age-related with less robust skulls in young children being more vulnerable to penetration. In infants the fibrous fontanels are also relatively easily penetrated both accidentally and in cases of homicide .
Non-missile penetrating injuries to the head are most often accidental occurring during vehicle crashes or in falls from heights, including ladders [15,16,17,18]. Material such as falling bamboo poles also have the capacity to penetrate thicker parts of the skull such as the parietal bone . One of the earliest described cases of a penetrating craniocerebral injury was that of Phineas Gage, a nineteenth century railway worker in the United States, who survived having a metal bar blown through his left frontal lobe, with a resultant frontal lobe syndrome . Penetrating wounds to the skull may also be suicidal and have again been caused by an array of objects including power drills and pencils [20, 21]. Rarely a weight has been dropped on the head forcing it downwards onto a metal spike .
Circular defects in the skull may arise from a variety of traumatic etiologies and may sometimes heal with no sequelae. Causes of circular defects that may be identified in calvarial remains include bullet holes, trephanation or blunt trauma . In the current case a circular punched out, circumscribed defect of the left parietal bone had been caused by the edges of a metal chair leg. Comparison of the base of the chair leg with the head wound clearly demonstrated corresponding dimensions.
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Bodwal, J., Chauhan, M., Behera, C. et al. An unusual patterned injury from homicidal craniocerebral impalement with a metal chair leg. Forensic Sci Med Pathol (2020). https://doi.org/10.1007/s12024-020-00289-2
- Penetrating injury
- Craniocerebral trauma
- Chair leg