Citation

Zack F, Rummel J, Wegener R, Buettner A. Rechtsmedizin 2009; 19(5): 341-344.

Copyright

(Copyright © 2009, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1007/s00194-009-0616-1

PMID

unavailable

Abstract

The case a highly alcoholised and excited 29year-old man who kicked a pregnant woman in the abdomen is reported. Mechanical restraints and pepper spray were used because the man resisted arrest and spat at the arresting police officers. The man was forced into a prone position so that a protective cover against spitting and biting could be put on. On arrival at an ophthalmic hospital sudden cardiac arrest occurred. After successful resuscitation (20 min) the patient was diagnosed as having suffered hypoxic brain damage. The blood alcohol concentration was 2.69 parts per thousand 2h later. Death occurred 8 days after the incident. Besides hypoxic brain damage no further pathological findings were found at autopsy. Histological investigations of the heart showed numerous partially pre-existing changes such as ischemic heart damage, mixed cellular destruction of the right bundle branch, fibromuscular dysplasia of isolated small coronary arteries, perivascular fibrosis with monocyte infiltration, lipomatosis of the bundle of His as well as a persistence of fetal dispersions within the anulus fibrosus. After autopsy the medical history was investigated by the police and showed that he had been admitted to hospital 4 times during the previous 2 years because of heart complaints under the strong influence of alcohol. As the cause of death hypoxic brain damage was determined after acute cardiac arrest as a consequence of an excited delirium under the influence of alcoholic with pre-existing morphologic alterations of the heart. The pathophysiological aspects of this case are discussed.