Sudden natural death in a suicide attempt.

Area of Science:

• Neurology
• Forensic Pathology
• Cardiovascular Medicine

Background:

• Suicide attempts can involve various methods, with varying degrees of lethality.
• Cerebral aneurysms, particularly basilar artery aneurysms, are a significant cause of subarachnoid hemorrhage.
• The interplay between external trauma and pre-existing vascular conditions in sudden death cases requires careful forensic examination.

Purpose of the Study:

• To report an unusual case of sudden death caused by a ruptured basilar artery aneurysm during a suicide attempt.
• To analyze the autopsy findings in relation to the gunshot wounds and the aneurysm.
• To discuss the cause and manner of death, considering contributing factors.

Main Methods:

• Case report and autopsy findings review.
• Examination of external injuries, including gunshot wounds.
• Detailed neuropathological examination, including identification of subarachnoid hemorrhage and subdural clot.
• Identification and characterization of the ruptured basilar artery aneurysm.

Main Results:

• A 72-year-old male with a history of depression and suicide intention died after sustaining superficial gunshot wounds to the forehead.
• Autopsy revealed no skull fractures or brain injuries from the non-penetrating bullet path.
• Subarachnoid hemorrhage and subdural clot were found around the brainstem and posterior fossa, directly linked to a ruptured basilar artery aneurysm.

Conclusions:

• The ruptured basilar artery aneurysm was the direct cause of death.
• The gunshot wounds, while part of a suicide attempt, were superficial and not the cause of death.
• This case highlights the importance of considering pre-existing vascular pathology in forensic investigations of deaths related to suicide attempts.