title: [Positional asphyxia--death in a head-down position after falling down stairs].
abstract: The discovery of a body in an unusual position such as a head-down position requires thorough investigation. In this article, such a death is reported. A 64-year-old man was found in a head-down position at the bottom of a narrow staircase after obviously falling down the stairs. His head was wedged between the last step and a closed sliding door. Autopsy revealed craniofacial blunt force injuries, a non-dislocated fracture of the 4th cervical vertebral body (with intact ligaments of the spine and cervical cord) and massive cerebral and pulmonary oedema. Although the heart was significantly enlarged (610 g), the coronary arteries showed only minor arteriosclerotic changes. The alcohol concentration measured was 2.06 per mil in blood and 2.67 per mil in urine. The alcohol intoxication increased the risk to fall and together with the trauma of the cervical spine made it impossible for the man to free himself so that he ultimately died in a head-down position.
authors.affiliation: Institut für Rechtsmedizin der Rheinischen Friedrich-Wilhelms-Universität, Bonn.
authors.forename: Elke
authors.initials: E
authors.lastname: Doberentz
authors.forename: Burkhard
authors.initials: B
authors.lastname: Madea
mesh_terms: D000058:Accidental Falls; D000435:Alcoholic Intoxication / Q000473:pathology; D001237:Asphyxia / Q000175:diagnosis* / Q000473:pathology*; D001344:Autopsy; D002574:Cervical Vertebrae / Q000293:injuries; D000431:Ethanol / Q000097:blood; D005684:Gait; D005858:Germany; D006801:Humans; D008099:Liver / Q000473:pathology; D008104:Liver Cirrhosis, Alcoholic / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011187:Posture; D012931:Social Environment; D016103:Spinal Fractures / Q000473:pathology; D014947:Wounds and Injuries / Q000473:pathology*; D055815:Young Adult
chemical_list: D000431:Ethanol