title: Contribution of Antemortem Computed Tomography Findings to Cause of Death Determination: An Unusual Fatal Stroke.
abstract: In the case reported here, the antemortem computed tomography scan (CT scan) was essential in the forensic investigation. A 32-year-old man was found fully awake with a facial abrasion, after what seemed to be a car accident. He lost consciousness suddenly one hour after initial management. Successive CT scan showed a facial fracture and a metallic foreign body in the carotid canal associated with an occlusion/dissection of the left internal carotid, a pseudoaneurysm, and a carotid-cavernous fistula. The victim died from a stroke. Autopsy confirmed that the facial abrasion was a gunshot entrance wound, the metallic foreign body being a projectile. Intracranial vascular injuries linked with gunshot wounds are most of the time isolated and due to pelet embolism. The observed vascular injury association has never been described in the existing literature. The CT scan provided a better understanding of the chronology of events that led to death.
authors.affiliation: Institut Médico-Légal, Université François Rabelais, Centre Hospitalier Régionnal Universitaire, Tours, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Rérolle
authors.affiliation: Pôle d'Imagerie M'dicale, Université François Rabelais, Centre Hospitalier Régional Universitaire, Tours, France.
authors.forename: Julien
authors.initials: J
authors.lastname: Pucheux
authors.affiliation: Centre de Pathologie, Le Vauban, 16 rue Clerget, BP 549, Nevers, 58009, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefrancq
authors.affiliation: Institut Médico-Légal, Université François Rabelais, Centre Hospitalier Régionnal Universitaire, Tours, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Barrault
authors.affiliation: Institut Médico-Légal, Université François Rabelais, Centre Hospitalier Régionnal Universitaire, Tours, France.
authors.forename: Pauline
authors.initials: P
authors.lastname: Saint-Martin
mesh_terms: D000328:Adult; D020215:Carotid Artery, Internal, Dissection / Q000000981:diagnostic imaging* / Q000209:etiology; D005147:Facial Bones / Q000000981:diagnostic imaging / Q000293:injuries; D005547:Foreign Bodies / Q000000981:diagnostic imaging*; D049429:Forensic Pathology; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008297:Male; D020521:Stroke / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014948:Wounds, Gunshot / Q000150:complications / Q000000981:diagnostic imaging*
keywords: computed tomography; fatal stroke; forensic pathology; forensic sciences; gunshot wound; vascular injury