Italy. A 19-year-old woman suffering from anorexia and depression (not pharmacologically treated) had experienced further exacerbation of her symptoms during the COVID-19 lockdown. The body of the young woman was discovered impaled with her head and right forearm on the spikes of the apartment building’s railing, suspended in midair. Shortly after the discovery, police officers, firefighters, and medical personnel reached the courtyard of the apartment building along with the mother of the victim, returning home from work.
Attachment 1268608 Fig.1 Image of the judicial on-site inspection. Attachment 1268609 Fig.2 The iron fence on which the girl’s body was found impaled through the head (arrow). Evidence of the window of the apartment where the girl lived and detail of the body in perpendicular correspondence (both indicated with arrows).
Inspection of the apartment, located on the sixth floor of the flat complex, did not reveal any sign of forced entry, the rooms appeared tidy. The bedroom window was discovered wide open and it was located at a height of 15 m (49 ft) above the highest part of the railing. The girl’s body could be noted in perpendicular correspondence with the open window, at a distance of 50 cm from the building wall. No farewell notes were found in the house, but there were several messages to friends on the victim’s cell phone, revealing deep inner suffering due to the social isolation and distance learning caused by the pandemic.
Attachment 1268610 Fig.3 RX image of the skull, with insertion of one of the sharpened ends of the fence.
A passerby stated that shortly before the discovery of the corpse, he had seen a girl standing at the window, turning around, and then falling into the void with her arms outstretched. Based on these reports and the position of the hands and arms, the hypothesis that the penetrating head injury could have resulted from an unsuccessful attempt to climb over the railing, during which she slipped, could be ruled out almost immediately. The parts of the fence connected to the body were cut off by the fire department officers, and the entire block was taken as a unicum to the Forensic Institute. The autopsy was performed three days after the event.
Attachment 1268611 Fig.4 Portion of the railing still in situ, with all the interconnections with the body preserved. Attachment 1268612 Fig.5 Entry point of the metal segment no. 2 in the right retro-mastoid area. Attachment 1268613 Fig.6 Exit wound with sharpened end protrusion in the left frontal area.
The corpse appeared in good condition of preservation (weight kg 35 (77 lbs); height cm 156(5' 1"); body mass index = 14.68 kg/m2). The external examination revealed a connection of the head and the right forearm with metal elements of the railing, which was confirmed by the radiographic examinations performed before the autopsy. The railing consisted of a bar to which three other metal elements (identified as no. 1, 2, and 3) were welded vertically, curved, and with sharpened cusps. Lateral elements, no. 1 and 3, had a completely extracorporeal course, whereas the central element, identified as no. 2, was characterized by an intracranial course with a right retro-mastoid origin that extended into the left frontal region, from which the pointed end protruded. Several abrasions were observed in the areas of contact of the grid with the body, especially to the back and the posterior surface of the neck. There was no evidence of defense lesions or aggression injuries by third parties.
Attachment 1268614 Fig.7 Metal portion of the railing after removal with curvature detail of segment no. 2 on which the impalement occurred.
After careful removal of the railing block, an internal examination of the head revealed a full-thickness fracture of the skull base in the right cerebellar fossa and of the cranial vault in the left frontal area. In both cases, the fracture section was clearly quadrangular in shape. At brain examination, a quadrangular cross-section of disintegrated parenchyma was observed from the right occipital region to the left frontal one. Further findings included the presence of blood in the cerebral ventricles and atlo-occipital diastasis. All blunt force injuries were macroscopically infiltrated with blood. No fractures were found on examination of the neck, which was consistent with the radiological evidence. No major findings were noted at the dissection of the chest and abdomen. Finally, the lungs showed no signs of blood aspiration.
Attachment 1268615 Fig.8 Exit lesion in the left frontal area with quadrangular section and presence of autonomized bone fragments. Attachment 1268616 Fig.9 Cranial base with evidence of the entry wound in the right cerebellar fossa and multiple fractures of the middle cranial fossa.
Toxicological analyses were negative for molecules of toxicological interest and routine histological examinations on the cutaneous margins of the injuries (head and forearm) showed hemorrhagic extravasations with features of vitality. At the conclusion of all investigations, the consistency and concordance of the circumstantial evidence and the autopsy and laboratory findings allowed to identify the cause of death as cranial penetrating trauma by impalement following suicidal falling from height.
From a forensic perspective, impalement is a rarely observed event, and the mechanism of the injury and how it occurred is important for its interpretation. Since wounds can have both contusive and penetrating aspects, diagnosis can be challenging, especially in cases with an unclear history or when the detrimental mean is not found in the body. In the presented case, a moving body impacted against a stationary object and was impaled on it, remaining suspended from the ground. Therefore, it can be claimed that not only an impalement occurred, but also that this finding may be the closest to what should be considered the definition of a true impalement.
Attachment 1268617 Fig.10 Macroscopic view of the brain with detail of the quadrangular section of disintegrated parenchyma.
In the presented case, moreover, as the impalement involved the skull following a suicidal fall from a great height, it is to be considered an even more peculiar and rare event given the small surface area of the head in relation to the rest of the body. Regardless of how intentional the fall was, the subsequent cranial blunt penetrating trauma could of course have been an accident. However, such finding has not yet been described in the literature. Indeed, there are only two reports of atypical skull impalement, one involving a bolt and a falling weight that forced the penetration of the object through the head and another describing the compression of the head with a hydraulic press.
- - -
This post is for educational purposes only and is nonprofit. Under Section 107 of the US Copyright Act of 1976; Allowance is made for "Fair Use" for purposes such as criticism, comment, news reporting, teaching, scholarship, and research. OP is not a medical expert. No copyright infringement intended. This post does not encourage or glorify violence/harassment. Images might have been upscaled and enhanced. Text might have been shortened and simplified/reorganized for online view.
