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Suicide by blunt head trauma – Two cases with striking similarities
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FSI-8116; No. of Pages 4 Forensic Science International xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Forensic Science International journal homepage: www.elsevier.com/locate/forsciint
Suicide by blunt head trauma – Two cases with striking similarities Hyejin Park a,*, Bongwoo Lee a, Connie Yoon b a b
Central Forensic Medical Center, National Forensic Service (NFS), Republic of Korea College of Dentistry, NYU, New York, United States
A R T I C L E I N F O
A B S T R A C T
Article history: Available online xxx
There have been several forensic pathological studies on the distinction between falls from height and homicidal blows in blunt head trauma, but few studies have focused on suicidal blows. Self-inflicted blunt head trauma is usually a part of a complex suicide with more than one suicidal method applied. Actually, no reports on suicide indicate blunt head trauma to be the singular cause of death in recent publications. Cases with self-inflicted blunt trauma are often challenging for those involved in the investigation because they are confronted with findings that are also found in homicides. A refined guideline to differentiate suicidal blows from homicidal blows in blunt head trauma allows for a more accurate representation of the events surrounding death. This paper presents two cases of suicide by self-inflicted blunt head trauma in which blunt head trauma from repeatedly hitting the decedent’s head with a hammer was considered to be the only cause of death. ß 2015 Elsevier Ireland Ltd. All rights reserved.
Keywords: Blunt head trauma Suicide Self-inflicted head trauma
1. Introduction
2. Case report
In blunt head trauma, discriminating falls from homicidal blows presents a common problem to forensic pathologists. To resolve this problem, several criteria have been proposed. Unlike falls and blows, there are few studies focused on blunt head trauma analysis in suicide. It is extremely rare to find blunt head trauma as one of the causes of death in suicide cases other than falling from heights – in fact, no reports on suicide indicate blunt head trauma to be the singular cause of death. The lack of blunt head trauma studies in suicide necessitates a refined guideline to differentiate blunt head trauma in suicides from homicides, as well as accidents. To identify the defining characteristics of suicide caused by blunt head trauma only, a 10-year retrospective study lasting from January 2003 until December 2012 was conducted on blunt head trauma cases from the National Forensic Service (NFS) database. Of 4981 cases of suicide, only two cases, with some concomitant circumstances indicating that a suicide had taken place, could be found. In two cases, self-inflicted blunt head trauma was considered to be the only cause of death.
2.1. Case 1
* Corresponding author at: Central Forensic Medical Center, National Forensic Service (NFS), 331-1, Shinwol7-dong, Yangcheon-gu, Seoul 158-707, Republic of Korea. Tel.: +82 2 2600 4600; fax: +82 2 2600 4744. E-mail address: [email protected] (H. Park).
A 64-year-old man was found dead on the kitchen floor lying in a supine position. There were heavy bloodstains on the floor around his body, and more were found elsewhere in the kitchen, bedroom, and bathroom as well as running down his face and scalp (Fig. 1). His wife first witnessed the scene. She found her deceased husband sitting on the floor, covered in blood marks and stains. She flipped him onto his back, resulting in the posture shown in Fig. 1. In the bathroom, a hammer weighing 2.4 kg was found with blood stains on the handle as well as on the head (Fig. 2). The main door of the house was locked. There were no signs of scuffle in his house. The decedent’s psychiatric history was fit for a diagnosis of depressive mood disorder and there was a previous suicide attempt by agricultural pesticides ingestion. At the autopsy, the only sources of significant hemorrhage were multiple scalp lacerations in the forehead, the crown of the head, and the occipital side of the scalp (Fig. 3). Internally, there was a round, ovoid depressed area of skull fracturing, with comminution, in the central parietal area where the multiple skin lacerations were concentrated (Fig. 4). There was no underlying cerebral damage or intracranial hemorrhage (Fig. 5) Toxicological analysis of the blood revealed a diazepam level of 0.04 mg/L in the blood. No defense injuries or other indications of
http://dx.doi.org/10.1016/j.forsciint.2015.08.002 0379-0738/ß 2015 Elsevier Ireland Ltd. All rights reserved.
Please cite this article in press as: H. Park, et al., Suicide by blunt head trauma – Two cases with striking similarities, Forensic Sci. Int. (2015), http://dx.doi.org/10.1016/j.forsciint.2015.08.002
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FSI-8116; No. of Pages 4 H. Park et al. / Forensic Science International xxx (2015) xxx–xxx
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Fig. 4. Fracture of the skull. Fig. 1. The scene of death showing blood stains and pools around the deceased.
Fig. 5. Cerebrum with no remarkable injury.
Fig. 2. Hammer with blood stains and bloody fingerprints.
Fig. 6. The scene of death showing pools of blood and blood stains on the floor and hammer. Fig. 3. Injuries on the vertex.
an assault were found. The analysis of the bloody fingerprints on the hammer handle could be identified as the decedent’s. It was concluded that the decedent had committed suicide by repeatedly hitting his head with a hammer. The cause of death was given as blunt head trauma. The hemorrhage from head trauma was thought to be a major mechanism of death in this case. 2.2. Case 2 A 64-year-old woman was found dead on her bedroom floor, lying in a supine position. Her son had been the last person to see
her alive on the morning of the day of her death. The deceased had a history of depression, and was receiving treatment. However, she had no history of suicide attempts, and a suicide note was not discovered at the scene of death. At the scene, she was found lying on her back with an obviously injured head and pooled blood under her body. There was a hammer near the body and blood splatters on the floor around her body, the walls, and the ceiling (Fig. 6). Extensive, heavy blood pools could be found in the hallway between a bathroom nearby and the bedroom (Fig. 7). After hitting her head with the hammer, it seems she made her way from the bedroom to the bathroom in order to obtain a towel from the bathroom cabinet.
Please cite this article in press as: H. Park, et al., Suicide by blunt head trauma – Two cases with striking similarities, Forensic Sci. Int. (2015), http://dx.doi.org/10.1016/j.forsciint.2015.08.002
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FSI-8116; No. of Pages 4 H. Park et al. / Forensic Science International xxx (2015) xxx–xxx
Fig. 7. Hallway between a bathroom nearby and the bedroom.
After visiting the bathroom, she had made some efforts to staunch the flow of blood with the towel. It also seems she rested for some time sitting on the stairs near the bedroom, bleeding heavily. Ultimately, she had returned and collapsed onto the bedroom floor where she died after a period of time. At the autopsy, the possible sources of bleeding were multiple full-thickness lacerations gathered in the vertex and one with a length of 4.8 cm in the left parietal region. Corresponding to the multiple lacerations gathered in the fronto-parietal region (Fig. 8), a round area of depressed skull fracturing, with comminution, was found (Fig. 9). There was a little subarachnoid hemorrhage in the left parietal lobe (Fig. 10).
Fig. 8. Injuries on the vertex.
Fig. 9. Fracture of skull.
3
Fig. 10. Subarachnoid hemorrhage in the left parietal lobe.
The laceration in the left parietal region was associated with an area of deep bruising, but the underlying skull was intact. No findings indicated a physical inability to act when the head injuries were inflicted. Toxicological analysis of the blood revealed a fluoxetine level of 0.13 mg/L in the blood. The analysis of the bloody fingerprints found on hammer was identified as the decedent’s. It was concluded that blunt head trauma was the cause of death and the primary mechanism responsible for death was hemorrhage. 3. Discussion According to the report by Statistics Korea, suicide was the leading cause of death among those aged 10–39 years in 2013, with the suicide rate rising significantly over the past decade [1]. The suicide rate may be considered high, but is low compared to those of some other western countries, e.g. Australia’s suicide rate is about 10–11 per 100,000. Suicide is now a major social issue due to high suicide rates [2]. The lethality of the suicide method employed is a strong risk factor for the completion of suicide. In Korea, hanging was the most common method of suicide for both males and females. Poisoning, drowning, falling, and sharp force injury came next [3–5]. The blunt force injury was the most uncommon cause among the methods of suicide. Of those, only two cases were confirmed to have blunt head trauma as the singular cause of death [4,5]. These two cases share morphological traits in head trauma and some concomitant circumstances. Both scalp lacerations and skull fractures are located above the HBL (hat brim lines). According to the HBL rule, a wound located above the HBL is more likely to result from a blow while a wound located inside the HBL is more often related to a fall [6–8]. In sharp contrast to homicidal blow, most lacerations form clusters on the vertex in these two cases. The large number of scalp lacerations, as previously investigated by Kremer and Sauvageau, are more likely to result from blows than falls [6–9]. The appearance of skull fracture showed the creation of a hole by multiple minimal depressed fractures with internal beveling in both cases. Also, the underlying dura was intact. As for weapon, a hammer was used in both cases. For the blunt objects of small surface area (like in these two cases of the tip of the hammer), when the impact is performed with very high velocity, the result is the creation of a hole by depressed fracture, frequently reproducing the shape of the used object. When the impact is delivered with great energy, the bone presents a fragmentation with bony penetration, with projection of the bony pieces toward the brain. If the force applied by the blunt force is not sufficient, the degree of depression is minimal [10,11,14].
Please cite this article in press as: H. Park, et al., Suicide by blunt head trauma – Two cases with striking similarities, Forensic Sci. Int. (2015), http://dx.doi.org/10.1016/j.forsciint.2015.08.002
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FSI-8116; No. of Pages 4 4
H. Park et al. / Forensic Science International xxx (2015) xxx–xxx
These two cases have similarities with assaults because of the large number of lacerations, but the severity of skull fracturing and relative lack of intracranial hemorrhage and lack of cerebral damage was comparatively slight. It means that the impact applied on head was performed with low kinetic energy for a homicidal blow. These morphologic differences can be useful in determining the manner of death in blunt head trauma. The clustering patterns of scalp lacerations and skull fractures would also be helpful to identify the suicidal blow. In addition, both cases revealed a medical history of depression treatment, and toxicant tests identified drugs associated with depression which can be regarded as clues to self-infliction [12,13]. Although suicide and homicide are difficult to distinguish from one another in blunt head trauma cases, this set of distinctive characteristics will help to accurately identify blunt head trauma suicide cases and improve the quality of judgment in determining the manner of death at a scene investigation. References [1] Statistics Korea Annual Report on the 2013 Causes of Death Statistics (Cities and provinces).
[2] Australian Bureau of Statistics. 3303.0 Causes of Death Australia 2012. [3] S. Park, M.H. Ahn, Associations between changes in the pattern of suicide methods and rates in Korea, the US, and Finland, Int. J. Ment. Health Syst. 8 (2014) 22–28. [4] J.Y. Na, J.P. Park, A statistical analysis on legal autopsy in 2011(The Headquarters of National Forensic Service), Korean J. Leg. Med. 36 (2012) 165–173. [5] J.Y. Na, J.P. Park, A statistical analysis on legal autopsy performed in Korea during 2012 year, Korean J. Leg. Med. 37 (2013) 198–207. [6] W.U. Spitz, D.J. Spitz, Spitz Fisher’s Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation, 4th ed., Charles C. Thomas, Springfield, IL, 2006, pp. 199–251. [7] P. Guyomarc’h, C. Kremer, Discrimination of falls and blows in blunt head trauma: a multi-criteria approach, J. Forensic Sci. 55 (2) (2010) 423–427. [8] C. Kremer, A. Sauvageau, Discrimination of falls and blows in blunt head trauma: assessment of predictability through combined criteria, J. Forensic Sci. 54 (4) (2009) 923–925. [9] E. Ehrlich, H. Maxeiner, External injury marks (wound) on the head in different types of blunt trauma in an autopsy series, Med. Law 21 (4) (2002) 773–782. [10] G.O. Hart, Fracture pattern interpretation in the skull: differentiating blunt force from ballistics trauma using concentric fractures, J. Forensic Sci. 50 (6) (2005) 1276–1281. [11] Y. Delannoy, A. Becart, Skull wounds linked with blunt trauma (hammer example). A report of two depressed skull fractures – elements of bio-mechanical explanation, Leg. Med. 14 (2012) 258–262. [12] A. Austin, C. Winskog, Recent trends in suicides utilizing helium, J. Forensic Sci. 56 (2011) 649–651. [13] A.E. Austin, Head impalement – an unusual form of suicide, J. Forensic Leg. Med. 19 (2012) 264–266. [14] M. Oehmichen, R.N. Auer, H.G. Ko¨nig, Forensic Neuropathology Associated Neurology, Springer-Verlag Berlin Heidelberg, New York, 2006.
Please cite this article in press as: H. Park, et al., Suicide by blunt head trauma – Two cases with striking similarities, Forensic Sci. Int. (2015), http://dx.doi.org/10.1016/j.forsciint.2015.08.002
FSI-8116; No. of Pages 4 Forensic Science International xxx (2015) xxx–xxx
Contents lists available at ScienceDirect
Forensic Science International journal homepage: www.elsevier.com/locate/forsciint
Suicide by blunt head trauma – Two cases with striking similarities Hyejin Park a,*, Bongwoo Lee a, Connie Yoon b a b
Central Forensic Medical Center, National Forensic Service (NFS), Republic of Korea College of Dentistry, NYU, New York, United States
A R T I C L E I N F O
A B S T R A C T
Article history: Available online xxx
There have been several forensic pathological studies on the distinction between falls from height and homicidal blows in blunt head trauma, but few studies have focused on suicidal blows. Self-inflicted blunt head trauma is usually a part of a complex suicide with more than one suicidal method applied. Actually, no reports on suicide indicate blunt head trauma to be the singular cause of death in recent publications. Cases with self-inflicted blunt trauma are often challenging for those involved in the investigation because they are confronted with findings that are also found in homicides. A refined guideline to differentiate suicidal blows from homicidal blows in blunt head trauma allows for a more accurate representation of the events surrounding death. This paper presents two cases of suicide by self-inflicted blunt head trauma in which blunt head trauma from repeatedly hitting the decedent’s head with a hammer was considered to be the only cause of death. ß 2015 Elsevier Ireland Ltd. All rights reserved.
Keywords: Blunt head trauma Suicide Self-inflicted head trauma
1. Introduction
2. Case report
In blunt head trauma, discriminating falls from homicidal blows presents a common problem to forensic pathologists. To resolve this problem, several criteria have been proposed. Unlike falls and blows, there are few studies focused on blunt head trauma analysis in suicide. It is extremely rare to find blunt head trauma as one of the causes of death in suicide cases other than falling from heights – in fact, no reports on suicide indicate blunt head trauma to be the singular cause of death. The lack of blunt head trauma studies in suicide necessitates a refined guideline to differentiate blunt head trauma in suicides from homicides, as well as accidents. To identify the defining characteristics of suicide caused by blunt head trauma only, a 10-year retrospective study lasting from January 2003 until December 2012 was conducted on blunt head trauma cases from the National Forensic Service (NFS) database. Of 4981 cases of suicide, only two cases, with some concomitant circumstances indicating that a suicide had taken place, could be found. In two cases, self-inflicted blunt head trauma was considered to be the only cause of death.
2.1. Case 1
* Corresponding author at: Central Forensic Medical Center, National Forensic Service (NFS), 331-1, Shinwol7-dong, Yangcheon-gu, Seoul 158-707, Republic of Korea. Tel.: +82 2 2600 4600; fax: +82 2 2600 4744. E-mail address: [email protected] (H. Park).
A 64-year-old man was found dead on the kitchen floor lying in a supine position. There were heavy bloodstains on the floor around his body, and more were found elsewhere in the kitchen, bedroom, and bathroom as well as running down his face and scalp (Fig. 1). His wife first witnessed the scene. She found her deceased husband sitting on the floor, covered in blood marks and stains. She flipped him onto his back, resulting in the posture shown in Fig. 1. In the bathroom, a hammer weighing 2.4 kg was found with blood stains on the handle as well as on the head (Fig. 2). The main door of the house was locked. There were no signs of scuffle in his house. The decedent’s psychiatric history was fit for a diagnosis of depressive mood disorder and there was a previous suicide attempt by agricultural pesticides ingestion. At the autopsy, the only sources of significant hemorrhage were multiple scalp lacerations in the forehead, the crown of the head, and the occipital side of the scalp (Fig. 3). Internally, there was a round, ovoid depressed area of skull fracturing, with comminution, in the central parietal area where the multiple skin lacerations were concentrated (Fig. 4). There was no underlying cerebral damage or intracranial hemorrhage (Fig. 5) Toxicological analysis of the blood revealed a diazepam level of 0.04 mg/L in the blood. No defense injuries or other indications of
http://dx.doi.org/10.1016/j.forsciint.2015.08.002 0379-0738/ß 2015 Elsevier Ireland Ltd. All rights reserved.
Please cite this article in press as: H. Park, et al., Suicide by blunt head trauma – Two cases with striking similarities, Forensic Sci. Int. (2015), http://dx.doi.org/10.1016/j.forsciint.2015.08.002
G Model
FSI-8116; No. of Pages 4 H. Park et al. / Forensic Science International xxx (2015) xxx–xxx
2
Fig. 4. Fracture of the skull. Fig. 1. The scene of death showing blood stains and pools around the deceased.
Fig. 5. Cerebrum with no remarkable injury.
Fig. 2. Hammer with blood stains and bloody fingerprints.
Fig. 6. The scene of death showing pools of blood and blood stains on the floor and hammer. Fig. 3. Injuries on the vertex.
an assault were found. The analysis of the bloody fingerprints on the hammer handle could be identified as the decedent’s. It was concluded that the decedent had committed suicide by repeatedly hitting his head with a hammer. The cause of death was given as blunt head trauma. The hemorrhage from head trauma was thought to be a major mechanism of death in this case. 2.2. Case 2 A 64-year-old woman was found dead on her bedroom floor, lying in a supine position. Her son had been the last person to see
her alive on the morning of the day of her death. The deceased had a history of depression, and was receiving treatment. However, she had no history of suicide attempts, and a suicide note was not discovered at the scene of death. At the scene, she was found lying on her back with an obviously injured head and pooled blood under her body. There was a hammer near the body and blood splatters on the floor around her body, the walls, and the ceiling (Fig. 6). Extensive, heavy blood pools could be found in the hallway between a bathroom nearby and the bedroom (Fig. 7). After hitting her head with the hammer, it seems she made her way from the bedroom to the bathroom in order to obtain a towel from the bathroom cabinet.
Please cite this article in press as: H. Park, et al., Suicide by blunt head trauma – Two cases with striking similarities, Forensic Sci. Int. (2015), http://dx.doi.org/10.1016/j.forsciint.2015.08.002
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FSI-8116; No. of Pages 4 H. Park et al. / Forensic Science International xxx (2015) xxx–xxx
Fig. 7. Hallway between a bathroom nearby and the bedroom.
After visiting the bathroom, she had made some efforts to staunch the flow of blood with the towel. It also seems she rested for some time sitting on the stairs near the bedroom, bleeding heavily. Ultimately, she had returned and collapsed onto the bedroom floor where she died after a period of time. At the autopsy, the possible sources of bleeding were multiple full-thickness lacerations gathered in the vertex and one with a length of 4.8 cm in the left parietal region. Corresponding to the multiple lacerations gathered in the fronto-parietal region (Fig. 8), a round area of depressed skull fracturing, with comminution, was found (Fig. 9). There was a little subarachnoid hemorrhage in the left parietal lobe (Fig. 10).
Fig. 8. Injuries on the vertex.
Fig. 9. Fracture of skull.
3
Fig. 10. Subarachnoid hemorrhage in the left parietal lobe.
The laceration in the left parietal region was associated with an area of deep bruising, but the underlying skull was intact. No findings indicated a physical inability to act when the head injuries were inflicted. Toxicological analysis of the blood revealed a fluoxetine level of 0.13 mg/L in the blood. The analysis of the bloody fingerprints found on hammer was identified as the decedent’s. It was concluded that blunt head trauma was the cause of death and the primary mechanism responsible for death was hemorrhage. 3. Discussion According to the report by Statistics Korea, suicide was the leading cause of death among those aged 10–39 years in 2013, with the suicide rate rising significantly over the past decade [1]. The suicide rate may be considered high, but is low compared to those of some other western countries, e.g. Australia’s suicide rate is about 10–11 per 100,000. Suicide is now a major social issue due to high suicide rates [2]. The lethality of the suicide method employed is a strong risk factor for the completion of suicide. In Korea, hanging was the most common method of suicide for both males and females. Poisoning, drowning, falling, and sharp force injury came next [3–5]. The blunt force injury was the most uncommon cause among the methods of suicide. Of those, only two cases were confirmed to have blunt head trauma as the singular cause of death [4,5]. These two cases share morphological traits in head trauma and some concomitant circumstances. Both scalp lacerations and skull fractures are located above the HBL (hat brim lines). According to the HBL rule, a wound located above the HBL is more likely to result from a blow while a wound located inside the HBL is more often related to a fall [6–8]. In sharp contrast to homicidal blow, most lacerations form clusters on the vertex in these two cases. The large number of scalp lacerations, as previously investigated by Kremer and Sauvageau, are more likely to result from blows than falls [6–9]. The appearance of skull fracture showed the creation of a hole by multiple minimal depressed fractures with internal beveling in both cases. Also, the underlying dura was intact. As for weapon, a hammer was used in both cases. For the blunt objects of small surface area (like in these two cases of the tip of the hammer), when the impact is performed with very high velocity, the result is the creation of a hole by depressed fracture, frequently reproducing the shape of the used object. When the impact is delivered with great energy, the bone presents a fragmentation with bony penetration, with projection of the bony pieces toward the brain. If the force applied by the blunt force is not sufficient, the degree of depression is minimal [10,11,14].
Please cite this article in press as: H. Park, et al., Suicide by blunt head trauma – Two cases with striking similarities, Forensic Sci. Int. (2015), http://dx.doi.org/10.1016/j.forsciint.2015.08.002
G Model
FSI-8116; No. of Pages 4 4
H. Park et al. / Forensic Science International xxx (2015) xxx–xxx
These two cases have similarities with assaults because of the large number of lacerations, but the severity of skull fracturing and relative lack of intracranial hemorrhage and lack of cerebral damage was comparatively slight. It means that the impact applied on head was performed with low kinetic energy for a homicidal blow. These morphologic differences can be useful in determining the manner of death in blunt head trauma. The clustering patterns of scalp lacerations and skull fractures would also be helpful to identify the suicidal blow. In addition, both cases revealed a medical history of depression treatment, and toxicant tests identified drugs associated with depression which can be regarded as clues to self-infliction [12,13]. Although suicide and homicide are difficult to distinguish from one another in blunt head trauma cases, this set of distinctive characteristics will help to accurately identify blunt head trauma suicide cases and improve the quality of judgment in determining the manner of death at a scene investigation. References [1] Statistics Korea Annual Report on the 2013 Causes of Death Statistics (Cities and provinces).
[2] Australian Bureau of Statistics. 3303.0 Causes of Death Australia 2012. [3] S. Park, M.H. Ahn, Associations between changes in the pattern of suicide methods and rates in Korea, the US, and Finland, Int. J. Ment. Health Syst. 8 (2014) 22–28. [4] J.Y. Na, J.P. Park, A statistical analysis on legal autopsy in 2011(The Headquarters of National Forensic Service), Korean J. Leg. Med. 36 (2012) 165–173. [5] J.Y. Na, J.P. Park, A statistical analysis on legal autopsy performed in Korea during 2012 year, Korean J. Leg. Med. 37 (2013) 198–207. [6] W.U. Spitz, D.J. Spitz, Spitz Fisher’s Medicolegal Investigation of Death: Guidelines for the Application of Pathology to Crime Investigation, 4th ed., Charles C. Thomas, Springfield, IL, 2006, pp. 199–251. [7] P. Guyomarc’h, C. Kremer, Discrimination of falls and blows in blunt head trauma: a multi-criteria approach, J. Forensic Sci. 55 (2) (2010) 423–427. [8] C. Kremer, A. Sauvageau, Discrimination of falls and blows in blunt head trauma: assessment of predictability through combined criteria, J. Forensic Sci. 54 (4) (2009) 923–925. [9] E. Ehrlich, H. Maxeiner, External injury marks (wound) on the head in different types of blunt trauma in an autopsy series, Med. Law 21 (4) (2002) 773–782. [10] G.O. Hart, Fracture pattern interpretation in the skull: differentiating blunt force from ballistics trauma using concentric fractures, J. Forensic Sci. 50 (6) (2005) 1276–1281. [11] Y. Delannoy, A. Becart, Skull wounds linked with blunt trauma (hammer example). A report of two depressed skull fractures – elements of bio-mechanical explanation, Leg. Med. 14 (2012) 258–262. [12] A. Austin, C. Winskog, Recent trends in suicides utilizing helium, J. Forensic Sci. 56 (2011) 649–651. [13] A.E. Austin, Head impalement – an unusual form of suicide, J. Forensic Leg. Med. 19 (2012) 264–266. [14] M. Oehmichen, R.N. Auer, H.G. Ko¨nig, Forensic Neuropathology Associated Neurology, Springer-Verlag Berlin Heidelberg, New York, 2006.
Please cite this article in press as: H. Park, et al., Suicide by blunt head trauma – Two cases with striking similarities, Forensic Sci. Int. (2015), http://dx.doi.org/10.1016/j.forsciint.2015.08.002