Fatal Gunshot Wound to the Head With Lack of Immediate Incapacitation

ABSTRACT Investigation of deaths caused by penetrating gunshot wounds to the head often raises the possibility of foul play. The forensic pathologist may be asked if the victim was able to perform certain acts after the gunshot, and how quickly this person might have become incapacitated. The possibility of a suicidal act can depend on these answers. We report the case of a 45-year-old woman whose body was found with a right temporal entrance wound. A shotgun was found 60 ft from the body location. The question of knowing if this woman had been able to shoot herself in the head and then walk a distance of 60 ft before dying was essential for the investigation, as suicide was the first hypothesis. The autopsy and a careful neuropathology investigation allowed to answer this question. In the literature, multiple publications report cases of victims who were able to act following penetrating ballistic head injury.

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    ABSTRACT: There are two distinct mechanisms of ballistic injury. Crushing of tissue resulting in a permanent tract is the primary factor in wounding of most tissues and most body regions. Temporary cavitation causes radial tissue displacement and subsequent shearing, compression and especially stretching of tissue analogous to blunt trauma. In contrast to the effect in elastic tissue, temporary cavitation can contribute substantially to wounding of inelastic tissue, such as the brain. This is the case in penetrating gunshot wounds to the head. Additionally, the penetration of the bony cranium can produce secondary missiles in the form of bone or bullet fragments and a tendency of the bullet to deformation and early yaw. Most important, wounding resulting from temporary cavitation is greatly augmented by the confined space provided by the unyielding walls of the skull. Bone contact and enhanced effects of temporary cavitation result in an enlarged zone of disintegrated tissue and in high intracranial peak pressures. Morphological signs of powerful intracranial pressure effects are cortical contusion zones, indirect skull fractures and perivascular haemorrhages remote from the tract. Depending on ballistic and anatomical parameters, the intracranial effect varies from slightly more severe injury than in isolated soft tissue to an "explosive" type of injury with comminuted fractures of the skull and laceration of the brain. Incapacitation is the physiologically based inability to perform complex and longer lasting movements independent of consciousness or intention. Immediate incapacitation is possible following cranio-cerebral gunshot wounds or wounds that disrupt the upper cervical spinal cord only. Rapid incapacitation can be produced by massive bleeding from major vessels or the heart. Immediate incapacitation is the result of primary intracranial effects of the bullet. A mechanism similar to commotion cerebri applied extracranially does not exist in cases of penetrating gunshot wounds to the head.
    Deutsche Zeitschrift für die Gesamte Gerichtliche Medizin 02/1995; 108(2):53-61. DOI:10.1007/BF01369905 · 2.60 Impact Factor
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    ABSTRACT: Because of the enhanced intracranial tissue disruption (see companion paper) and the functional significance of the central nervous system, penetrating gunshot wounds of the head commonly result in immediate incapacitation. However, in the last century numerous publications reported sustained capability to act following penetrating gunshot wounds of the head. These are reviewed. A large number of case reports had to be excluded from re-examination because of doubtful capability to act or lack of morphological documentation. There remained 53 case reports from 42 sources for systematic analysis. Favourable conditions for sustained capability to act are present in cases where the additional wounding resulting from the special wound ballistic qualities of the head (see companion paper) are minimized. Thus, more than 70% of the guns used fired slow and lightweight bullets: 6.35 mm Browning, .22 rimfire or extremely ineffective projectiles (ancient, inappropriate or selfmade). A centre-fire rifle or a shotgun from close range were never employed in cases involving intracerebral tracts. A coincidence of several lucky circumstances made sustained capability to act possible in two cases of military centrefire rifle bullets passing longitudinally between the frontal lobes without direct contact with brain tissue. Only two large handguns resulting in intracerebral wounding were used: one firing a .38 special bullet, which solely wounded the base of the right temporal lobe and one firing a .45 lead bullet, which seriously injured the left frontal lobe but whose trajectory was limited to the anterior fossa of the skull. Of the trajectories, 28% were outside the neurocranium. At least 70% of the craniocerebral tracts passed above the anterior fossa of the skull, wounding the frontal parts of the brain. Apart from a neurophysiological approach, this preference can be explained by the fact that the base of the anterior cranial fossa and the sella turcica area serve as a bony barrier protecting the parts of the brain located in its "shadow"' relative to the trajectory against cavitational tissue displacement and associated overpressures. This is particularly true of the brain stem. Intracerebral trajectories not located above the anterior fossa were caused by slow and lightweight bullets preferring one temporal lobe. Additionally, one parietal and one occipital lobe were each injured once by a very ineffective projectile and by a 7.65-mm bullet reduced in velocity. Not a single case of injury to the brain stem, the diencephalon, the cerebellum or major paths of motor conduction and only one grazing shot of the anterior parts of the nucleus caudatus (basal ganglia) were described. Morphological signs of high intracranial pressure peaks (cortical contusion zones, indirect skull fractures, perivascular haemorrhages) and secondary missiles were poorly documented. It is suggested that these findings are at least very rare and not obvious in cases of sustained capability to act.
    Deutsche Zeitschrift für die Gesamte Gerichtliche Medizin 02/1995; 108(3):117-26. DOI:10.1007/BF01844822 · 2.60 Impact Factor
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    ABSTRACT: Out of 138 clearly defined gunshot suicides which were autopsied, 11 persons (8%) fired two or more gunshots to the body. From these 11, 5 cases involved 2 gunshots to the head where the bullets fired first had missed the brain. The trajectories were restricted to the chest in three cases and a combination of gunshots to the head and chest including two perforating heart wounds without immediate incapacitation occurred in three more cases. Reliable incapacitation is based on physiological effects (tissue disruption) and can only be achieved by decreasing the functioning capability of the CNS. This can be accomplished by direct disruption of brain tissue or indirectly by cerebral hypoxemia from massive bleeding. Targets of immediate incapacitation are restricted to certain CNS areas and targets of rapid incapacitation include the heart, the (thoracic) aorta and the pulmonary artery. Other major blood vessels and major organs (lungs, kidneys, liver, spleen) constitute targets of delayed incapacitation. This general classification can be derived from the literature and is illustrated by the cases presented. A thorough post mortem can exclude or quantify the potential for physical activity. Typical features of single gunshot suicides such as contact shots, classical entrance wound sites and soot/backspatter on a hand also occur in multiple gunshot suicides.
    Deutsche Zeitschrift für die Gesamte Gerichtliche Medizin 02/1997; 110(4):188-92. DOI:10.1007/s004140050065 · 2.60 Impact Factor