title: Reflex mechanisms of death in missile injuries of the neck.
abstract: Three cases of missile injury to the neck are reported, two homicides and one suicide. In two fatalities, the autopsy revealed contusion of the spinal cord due to direct missile injury of the cervical spine but without laceration of the spinal dura. It was concluded that the temporary cavity following penetration of the bullet caused contusion of the spinal cord with subsequent reflex cardiac arrest. In the suicide case, the entrance wound was in the mouth, the bullet track traversed the pharynx and the cervical spine with complete transection of the cord, and the bullet lodged in the right scalenus muscle. The lack of vital signs such as blood aspiration, which was expected because of the injury of the pharynx, also indicates immediate occurrence of death owing to a reflex mechanism in this case. The underlying reflex mechanisms are discussed in the light of clinical experience in the treatment of paraplegics as well as the findings in experimental contusion and transection of the cervical cord.
authors.affiliation: Institute of Forensic Medicine, University of Cologne, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Schmidt
authors.forename: B
authors.initials: B
authors.lastname: Madea
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003288:Contusions / Q000473:pathology; D016757:Death, Sudden, Cardiac; D005260:Female; D006323:Heart Arrest / Q000503:physiopathology; D006708:Homicide; D006801:Humans; D008297:Male; D019838:Neck Injuries; D012018:Reflex; D013119:Spinal Cord Injuries / Q000473:pathology / Q000503:physiopathology*; D013405:Suicide; D014948:Wounds, Gunshot / Q000473:pathology / Q000503:physiopathology*