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Case Reports
. 2024 Dec;20(4):1458-1463.
doi: 10.1007/s12024-024-00784-w. Epub 2024 Mar 27.

Determining the manner of death in victims in drug-induced psychosis: a case of an atypical head stab wound

Petr Handlos  1   2 , Ondřej Klabal  3 , Vladimír Vojtek  4 , Klára Handlosová  1   2 , Tomáš Krejčí  5   6 , Matěj Uvíra  7   8
Affiliations
Case Reports

Determining the manner of death in victims in drug-induced psychosis: a case of an atypical head stab wound

Petr Handlos et al. Forensic Sci Med Pathol. 2024 Dec.

Abstract

This case report presents a rare case of an atypical head stab wound suffered by a drug addict and inflicted with a screwdriver during drug-induced psychosis. It describes the diagnostic and treatment procedures in the hospital and the findings of the subsequent autopsy. It also analyzes the review of the interpretation of the CT scans made upon admission and the subsequent treatment by an independent medical review panel, which revealed signs of medical mismanagement. Therefore, it also discusses the legal consequences that the case may have involved for the attending physicians in addition to the consequences for the suspected perpetrator. The report raises many issues encountered in the case in terms of the clinical treatment and forensic determination of the manner of death in cases of injuries caused by sharp instruments and highlights the importance of comprehensive evaluation of the circumstantial evidence together with the clinical or autopsy findings, since such evidence may sometimes be overlooked in clinical practice.

Keywords: Cavernous sinus; Drug-induced psychosis; Hemorrhagic shock; Screwdriver; Stab wound; Suicide.

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Conflict of interest statement

Declarations. Ethical approval: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration. Conflict of interest: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Screwdriver-inflicted stab wound on the left portion of the victim’s forehead (arrow in A) with the zoom-in of the wound (inset in A). Subarachnoid hemorrhage at the base of the left temporal lobe and minor brain contusions around the stab track (arrow in B). Visualization of the sphenoid bone penetration (probe in C) and blood in the sphenoid sinus (arrow in C). Blood with no signs of digestion present in the large intestine (D)
Fig. 2
Fig. 2
CT scan of the head in the axial and coronal plane displaying the stab track (yellow line in A and B, respectively). Blood in the right portion of the sphenoid sinus (red arrowhead in C), hypoplasia of the left portion of the sphenoid sinus with the presence of gas (blue arrowhead in C), blood in the stab track (arrow in C). The 3D reconstruction of the skull with penetration of the left temporal bone and sphenoid sinus (arrowheads in D)
Fig. 3
Fig. 3
The screwdriver collected at the scene
See this image and copyright information in PMC

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