Abstract
Although deaths of persons in a head-down position are rare events, there can be no doubt that they occur from time to time, most often accidentally. The prolonged head-down position itself may lead to fatal outcome. The common features of such cases are as follows: (a) the finding of a body in an inverted or head-down tilted position; (b) marked (“monstrous”) congestion of face, scalp, neck, and other dependent parts of the body (e.g., hands, shoulders); (c) accompanying effects of internal congestion with swelling of and petechial bleedings at the affected parts as well as edema of the brain and lungs; and (d) lack of a definite pathoanatomical cause of death. In some cases, one may find traces of self-rescuing attempts on the deceased’s body as well. Because postmortem examinations are unlikely to reveal the cause of death in such cases, additional pathophysiological considerations are required to make this determination. This chapter examines 10 cases in which the deceased was found in a head-down position. Based on these cases, it is observed that elderly people, and in particular elderly with preexisting cardiovascular diseases, seem to be more prone to death in a head-down position than others. This suggests that final heart failure is the cause of death rather than cerebral or pulmonary dysfunction. Results from human and animal experiments and observations under true and simulated microgravitational conditions confirm this assumption, suggesting that a prolonged, markedly elevated burden of work for the heart because of increased volume load in an inverted body position eventually leads to death by heart failure. Other mechanisms, such as suffocation (“positional asphyxia”), reduced blood reflux to the heart attributable to vanishing of blood in the venous system, decreased oxygen supply to the brain after reduced arteriovenous pressure difference, and carotid sinus or baroreceptor reflexes as well as other factors seem to play only a minor role, if any, in deaths in head-down position.
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© 2005 Humana Press Inc., Totowa, NJ
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Schäfer, A.T. (2005). Death in a Head-Down Position. In: Tsokos, M. (eds) Forensic Pathology Reviews. Forensic Pathology Reviews, vol 3. Humana Press. https://doi.org/10.1007/978-1-59259-910-3_3
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DOI: https://doi.org/10.1007/978-1-59259-910-3_3
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