Death in head-down position in a heavily intoxicated obese man

Area of Science:

• Forensic Pathology
• Toxicology

Background:

• Positional asphyxia is a rare cause of death, often presenting with subtle or absent morphological findings.
• This case report examines a unique instance of a 78-year-old man found deceased in a head-down position.

Observation:

• The deceased was found suspended by his leg in a blackberry bush, exhibiting cyanosis and petechial hemorrhages.
• Autopsy revealed pulmonary and cerebral edema, cardiac enlargement, and arterial calcification.
• Significant findings included acute alcoholic intoxication (blood alcohol concentration 2.10 g/l) and obesity (BMI 33.4).

Findings:

• The primary cause of death was positional asphyxia, exacerbated by acute alcohol intoxication.
• Obesity and pre-existing cardiovascular changes may have contributed to the fatal outcome.
• Toxicological screening for illicit drugs was negative, ruling out other common causes.

Implications:

• This case highlights the critical role of alcohol and obesity as co-factors in positional asphyxia deaths.
• It underscores the importance of thorough toxicological and pathological examination in unexplained deaths.
• Understanding these contributing factors is crucial for accurate forensic investigations.