Skip to main content
View expanded cover

Forensic Pathology Reviews pp 137–154Cite as

Death in a Head-Down Position

  • Chapter

Part of the Forensic Pathology Reviews book series (FPR,volume 3)

Abstract

Although deaths of persons in a head-down position are rare events, there can be no doubt that they occur from time to time, most often accidentally. The prolonged head-down position itself may lead to fatal outcome. The common features of such cases are as follows: (a) the finding of a body in an inverted or head-down tilted position; (b) marked (“monstrous”) congestion of face, scalp, neck, and other dependent parts of the body (e.g., hands, shoulders); (c) accompanying effects of internal congestion with swelling of and petechial bleedings at the affected parts as well as edema of the brain and lungs; and (d) lack of a definite pathoanatomical cause of death. In some cases, one may find traces of self-rescuing attempts on the deceased’s body as well. Because postmortem examinations are unlikely to reveal the cause of death in such cases, additional pathophysiological considerations are required to make this determination. This chapter examines 10 cases in which the deceased was found in a head-down position. Based on these cases, it is observed that elderly people, and in particular elderly with preexisting cardiovascular diseases, seem to be more prone to death in a head-down position than others. This suggests that final heart failure is the cause of death rather than cerebral or pulmonary dysfunction. Results from human and animal experiments and observations under true and simulated microgravitational conditions confirm this assumption, suggesting that a prolonged, markedly elevated burden of work for the heart because of increased volume load in an inverted body position eventually leads to death by heart failure. Other mechanisms, such as suffocation (“positional asphyxia”), reduced blood reflux to the heart attributable to vanishing of blood in the venous system, decreased oxygen supply to the brain after reduced arteriovenous pressure difference, and carotid sinus or baroreceptor reflexes as well as other factors seem to play only a minor role, if any, in deaths in head-down position.

Key Words

  • Head-down position
  • positional asphyxia
  • inverted suspension
  • cardiovascular dysfunction
  • heart failure
  • blood distribution
  • congestion

This is a preview of subscription content, access via your institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-1-59259-910-3_3
  • Chapter length: 18 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   219.00
Price excludes VAT (USA)
  • ISBN: 978-1-59259-910-3
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Softcover Book
USD   279.99
Price excludes VAT (USA)
Hardcover Book
USD   279.99
Price excludes VAT (USA)
Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Schwarz F (1970) Der außergewöhnliche Todesfall. Enke, Stuttgart.

    Google Scholar 

  2. Prokop O, Radam G (1987) Atlas der gerichtlichen Medizin. Karger, Basel.

    Google Scholar 

  3. Hilgermann R, Richter O (1973) Einige besondere Fälle aus dem rechtsmedizinischen Obduktionsgut. Beitr Gerichtl Med 30, 163–174.

    PubMed  CAS  Google Scholar 

  4. Yoshida K, Harada K, Sorimachi Y, Makisumi T (1995) Death in head-down position: An autopsy report with reference to physiological mechanism. Jpn J Legal Med 49, 33–36.

    CAS  Google Scholar 

  5. Purdue B (1992) An unusual accidental death from reverse suspension. Am J Forensic Med Pathol 13, 108–111.

    PubMed  CAS  CrossRef  Google Scholar 

  6. Marshall TK (1968) Inverted suspension. Med Sci Law 8, 49–50.

    PubMed  CAS  Google Scholar 

  7. Madea B (1993) Death in a head-down position. Forensic Sci Int 61, 119–132.

    PubMed  CrossRef  CAS  Google Scholar 

  8. Thiel I, Huckenbeck W (2003) Der kalte Tod an der Treppe. SeroNews 8, 32–34.

    Google Scholar 

  9. Kauffmann F (1927) Einfluss des hydrostatischen Drucks auf die Blutbewegung, Anpassung der Gefäße. In Bethe A, Bergmann G v, Embden G, Ellinger A, eds., Handbuch der normalen und pathologischen Physiologie, Vol. VII, part 2. Springer, Berlin, pp. 1414–1439.

    Google Scholar 

  10. Uchigasaki S, Takahashi H, Suzuki T (1999) An experimental study of death in a reverse suspension. Am J Forensic Med Pathol 20, 116–119.

    PubMed  CrossRef  CAS  Google Scholar 

  11. Wilkins RW, Bradley SE, Friedland CK (1950) 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 29, 940–949.

    PubMed  CAS  CrossRef  Google Scholar 

  12. Deklunder G, Lecroart JL, Chammas E, Goullard L, Houdas Y (1993) Intracardiac hemodynamics in man during short periods of head-down and head-up tilt. Aviat Space Environ Med 64, 43–49.

    PubMed  CAS  Google Scholar 

  13. Folkow B, Heymans C, Neill E (1965) Integrated aspects of cardiovascular regulation. In Hamilton WF, Dow P, eds., Handbook of Physiology, Sect. 2, Vol. III. American Physiological Society, Washington DC, pp. 1787–1823.

    Google Scholar 

  14. Gauer OH, Thron HL (1965) Postural changes in the circulation. In Hamilton WF, Dow P, eds., Handbook of Physiology, Sect. 2, Vol. III. American Physiological Society, Washington DC, pp. 2409–2439.

    Google Scholar 

  15. Shulzhenko EB, Panfilov VE, Gogolev KI, Aleksandrova EA (1979) Comparison of physiological effects of head-down tilting and immersion on the human body. Aviat Space Environ Med 50, 1020–1022.

    PubMed  CAS  Google Scholar 

  16. Kirsch KA, Baartz FJ, Gunga HC, Röcker L, Wicke HJ, Bünsch B (1993) Fluid Shifts into and out of superficial tissues under microgravity and terrestrial conditions. Clin Invest 71, 687–689.

    CrossRef  CAS  Google Scholar 

  17. Loeppky JA, Roach RC, Selland MA, Scotto P, Luft FC, Luft UC (1993) Body fluid alterations during head-down bed rest in men at moderate altitude. Aviat Space Environ Med 64, 265–274.

    PubMed  CAS  Google Scholar 

  18. Loeppky JA, Roach RC, Selland MA, Scotto P, Greene ER, Luft UC (1993) Effects of prolonged head-down bed rest on physiological responses to moderate hypoxia. Aviat Space Environ Med 64, 275–286.

    PubMed  CAS  Google Scholar 

  19. Baisch FJ, Petrat G (1993) Body fluid distribution in man in space and effect of lower body negative pressure treatment. Clin Invest 71, 690–699.

    CrossRef  CAS  Google Scholar 

  20. Draeger J, Schwartz R, Groenhoff S, Stern C (1993) Self-tonometry under microgravity conditions. Clin Invest 71, 700–703.

    CrossRef  CAS  Google Scholar 

  21. Mader TH, Gibson CR, Caputo M, Hunter N, Taylor G, Charles J, et al. (1993) Intraocular pressure and retinal vascular changes during transient exposure to microgravity. Am J Ophthalm 115, 347–350.

    CAS  Google Scholar 

  22. Drummer C, Heer M, Dressendörfer RA, Strasburger CJ, Gerzer R (1993) Reduced natriuresis during weightlessness. Clin Invest 71, 678–686.

    CrossRef  CAS  Google Scholar 

  23. Lacolley PJ, Pannier BM, Cuche JL, et al. (1993) Microgravity and orthostatic intolerance: carotid hemodynamics and peripheral responses. Am J Physiol 264, H588–H594.

    PubMed  CAS  Google Scholar 

  24. Frey MAB, Mader TH, Bagian JP, Charles JB, Meehan RT (1993) Cerebral blood velocity and other cardiovascular responses to 2 days of head-down tilt. J Appl Physiol 74, 319–325.

    PubMed  CAS  Google Scholar 

  25. Harrison MH, Rittenhouse D, Greenleaf JE (1986) Effect of posture on arterial baroreflex control of heart rate in humans. Eur J Appl Physiol 55, 367–373.

    CrossRef  CAS  Google Scholar 

  26. Yamazaki F, Matsumura N, Nagata J, Ando A, Imura T (2001) Spontaneous arterial baroreflex control of the heart rate during head-down tilt in heat-stressed humans. Eur J Appl Physiol 85, 208–213.

    PubMed  CrossRef  CAS  Google Scholar 

  27. Trumbach S (1988) Glukose-Toleranz und Insulin-Sekretion unter simulierter Schwerelosigkeit. Medical Thesis, RWTH Aachen, Germany.

    Google Scholar 

  28. Allmers H (1992) Zirkadiane Rhythmik bei der Simulation eines D-2 Weltraumfluges. Medical Thesis, RWTH Aachen, Germany.

    Google Scholar 

  29. Lathers CM, Diamandis PH, Riddle JM, Mukai C, Elton KF, Bungo MW, et al. (1990) Acute and intermediate cardiovascular responses to zero gravity and to fractional gravity levels induced by head-down or head-up tilt. J Clin Pharmacol 30, 494–523.

    PubMed  CAS  Google Scholar 

  30. Schmidt P, Madea B (2004) Tod in abnormer Körperposition—Physical restraint. In Madea B, ed., Praxis Rechtsmedizin. Springer, Berlin, pp. 204–208.

    Google Scholar 

  31. Glatter K, Karch SB (2004) Positional asphyxia: inadequate oxygen, or inadequate theory? Forensic Sci Int 141, 201–202.

    PubMed  CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Office of Medicolegal Assessment, Aachen, Germany

    Achim Th. Schäfer MD

Authors
  1. Achim Th. Schäfer MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Institute of Legal Medicine, University of Hamburg, Hamburg, Germany

    Michael Tsokos MD

Rights and permissions

Reprints and Permissions

Copyright information

© 2005 Humana Press Inc., Totowa, NJ

About this chapter

Cite this chapter

Schäfer, A.T. (2005). Death in a Head-Down Position. In: Tsokos, M. (eds) Forensic Pathology Reviews. Forensic Pathology Reviews, vol 3. Humana Press. https://doi.org/10.1007/978-1-59259-910-3_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-59259-910-3_3

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-416-6

  • Online ISBN: 978-1-59259-910-3

  • eBook Packages: MedicineMedicine (R0)