Forensic Science International 254 (2015) e18–e21
Contents lists available at ScienceDirect
Forensic Science International journal homepage: www.elsevier.com/locate/forsciint
Case report
An unusual homicidal stab wound of the cervical spinal cord: A single case examined by post-mortem computed tomography angiography (PMCTA) Frederic Savall a,*, Fabrice Dedouit a,b, Fatima-Zohra Mokrane b, Daniel Rouge´ a, Pauline Saint-Martin c, Norbert Telmon a a
Service de Me´decine Le´gale, Centre Hospitalier Universitaire Rangueil, Avenue du Professeur Jean Poulhe`s, 31403 Toulouse Cedex 4, France Service de Radiologie, Centre Hospitalier Universitaire Rangueil, Avenue du Professeur Jean Poulhe`s, 31403 Toulouse Cedex 4, France c Service de Me´decine Le´gale, Centre Hospitalier Universitaire Trousseau, Avenue de la Re´publique, 37170 Chambray-le`s-Tours, France b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 11 May 2015 Received in revised form 12 June 2015 Accepted 26 June 2015 Available online 6 July 2015
We report an unusual case of homicidal stab wound of the cervical spinal cord, which illustrates the value of post-mortem computed tomography angiography (PMCTA) in cases of vascular injury. First, we noted a posterior and horizontal trajectory to the neck with complete section of the cervical spinal cord between the first and second cervical vertebrae. This lesion was accompanied by section of the right vertebral and right deep cervical arteries. We also noted an anterior cervical trajectory with an injury to the right internal jugular vein and an anterior right chest wound with a lung trajectory and section of the internal mammary vessels. Cases of spinal cord injuries secondary to stab wounds are rare in the literature. Only one large series has been published from Cape Town. Complete section of the cervical spinal cord accounts for only 4.5% of all cases. Furthermore, lethal cases are rare and classically victims survive and present neurological sequelae. We found only one similar case but despite the transection of the cervical spinal cord the patient survived. Some studies suggest that PMCTA may be very helpful in visualizing vascular system injuries. Our observations are consistent with this proposal. The use of different-time acquisitions was essential for detection of the injured vessels. ß 2015 Elsevier Ireland Ltd. All rights reserved.
Keywords: Cervical stab wound Spinal cord injury Post-mortem computed tomography angiography (PMCTA) Autopsy
1. Introduction In France, homicides by sharp instruments are as numerous as homicides by firearms, probably because there is strict firearms legislation (respectively 116 and 125 reported in 2010) [1,2]. In contrast, the same year, the United States’ National Violent Death Reporting System reported 2615 homicides by firearms and only 503 homicides by sharp instruments in 16 states [3]. In cases of homicide, sharp wounds to the neck are rare in the literature. In a recent review, the thorax was the most common site of injury, and the neck was involved in only 9.3% of cases [4]. In North America, between 1996 and 2008, spinal fracture represented 5.8% of the 44 455 patients of the Los Angeles County and University of Southern California Medical Centre and. 21.7% of patient with spinal fractures presented spinal cord injury. Penetrating injuries (gunshot wounds and stab wounds) were
* Corresponding author. Tel.: +033 05 61 32 28 59; fax: +033 05 61 32 21 77. E-mail address: [email protected] (F. Savall). http://dx.doi.org/10.1016/j.forsciint.2015.06.025 0379-0738/ß 2015 Elsevier Ireland Ltd. All rights reserved.
responsible for 14.1% of spinal injuries, with gunshot wounds accounting for a large population (86.5%) of these injuries. The most common causes of spinal injuries were motor vehicle accidents (32.6%) [5]. The recent use of post-mortem computed tomography angiography (PMCTA) offers the potential for analysis of cases of violent death by sharp instruments. Indeed, it could play a role in the detection of vascular and solid organ lesions [6]. We report an unusual case of homicidal stab wound of the cervical spinal cord, which illustrates the value of post-mortem computed tomography angiography (PMCTA) in cases of vascular injury. 2. Methods Before the PMCTA, the body was prepared by surgical cannulation of the femoral vessels (Maquet GmbH & co. KG, Rastatt, Germany). Prior to perfusion, toxicological samples (blood, bile, urine and hemothorax in our case) were collected. Following exploration, a controlled perfusion device (Virtangio1 machine)
F. Savall et al. / Forensic Science International 254 (2015) e18–e21
was used to administer paraffin oil mixed with special contrast agent (Angiofil1), allowing three different-time acquisitions: arterial, venous and dynamic (arterial injection with concomitant venous aspiration). The controlled perfusion machine (Virtangio, Fumedica AG, Muri, Switzerland) and the protocol used were developed by Grabherr et al. [7]. Two board-certified radiologists proceeded to analyze the images and two board-certified forensic pathologists performed an autopsy. The forensic pathologists conducting the autopsy were aware of the preliminary imaging results. 3. Case 3.1. Case history We report the case of a 26-year-old woman killed by her boyfriend in the context of separation. Her boyfriend was a butcher and he stabbed her several times with a chef’s knife (Fig. 1). 3.2. PMACT and autopsy findings The external examination revealed facial, cervical and thoracic stab wounds and defense stab wounds to the hands and forearms. At the cervical level, we noted two lesional trajectories. The first
e19
was located on the upper posterior part of the neck, with a horizontal trajectory, and complete transversal section of the cervical spinal cord, between the first and second cervical vertebrae (C1 and C2) (Fig. 2). This lesion was accompanied by section of the right vertebral and right deep cervical arteries (Fig. 3). The second lesion was anterior, located on the right side, at the base of the neck, and along its trajectory presented an injury of the right internal jugular vein, and section of the right transverse apophysis of the 7th cervical vertebrae (Fig. 4). We also noted two right cheek wounds with fractures of the mandible, one anterior right chest wound with a lung trajectory and section of the internal mammary vessels (Fig. 5), and one posterior right chest wound with one scapula bone lesion and a lung trajectory. Both chest trajectories had caused a major right pneumothorax and a hemothorax of 190 cm3. 4. Discussion Cases of spinal cord injuries secondary to stab wounds are rare in the literature. Only one large series has been published from Cape Town (South Africa). That study included 450 cases of stab wounds. Cervical spinal cord injury represented 29.5% of injuries but in most of these cases spinal cord injury was incomplete, and complete transection of the spinal cord was only found in 4.5% of all cases [8]. Furthermore, lethal cases are rare and classically
Fig. 1. The chef’s knife used.
Fig. 2. Posterior cervical trajectory. (A) Posterior cervical trajectory. (B) Section of the spinal cord between the first and second cervical vertebrae. (C) Post-mortem computed tomography: coronal view of the posterior cervical trajectory. (D) Post-mortem computed tomography: sagittal view of the vertebral canal. Section of the spinal cord between the first and second cervical vertebrae (arrowhead).
e20
F. Savall et al. / Forensic Science International 254 (2015) e18–e21
Fig. 3. Post-mortem computed tomography angiography: cervical arteries section. (A) Arterial phase: visualization of the left vertebral artery (arrow) and section of the right vertebral artery (circle). (B) Dynamic phase: section of the right deep cervical artery (arrowhead).
Fig. 4. Anterior cervical trajectory. (A) Injury of the right internal jugular vein (arrow). (B) Post-mortem computed tomography: axial view of the anterior cervical trajectory with a section of the right transverse apophysis of the 7th cervical vertebrae. (C) Venous phase of the post-mortem computed tomography angiography: injury of the right internal jugular vein (star).
victims survive and present neurological sequelae such as tetraplegia, paraplegia or Brown–Sequard syndrome [9,10]. In a case series study of 57 patients of the Taleqani Trauma Center (Kermanshah, Iran), only four patients died but 22 with paraplegia showed relatively complete recovery [11].
According to Lipschitz et al., the direction of the stab wound is classically upwards in the thoracic region and horizontal or downwards in the cervical region [9]. Peacock et al. highlighted that the high incidence of incomplete transection could be explained by the anatomy of the vertebral column. The transverse and spinous
F. Savall et al. / Forensic Science International 254 (2015) e18–e21
e21
Fig. 5. Anterior right chest trajectory. (A) Chest wound and lesional trajectory. (B) Arterial phase of the post-mortem computed tomography angiography: lung trajectory (arrow) and hemothorax (star). (C) Dynamic phase of the post-mortem computed tomography angiography: section of the internal mammary vessels (circle).
processes produce a gutter along which the blade would run before penetrating the spinal canal [8]. In our case, the horizontal trajectory in the cervical region permitted complete transection of the spinal cord between C1 and C2. We found only one similar case (i.e. horizontal trajectory and complete transection of the spinal cord between C1 and C2) in the literature. However, despite the transection of the cervical spinal cord the patient remained alive. In this case Rubin et al. enhanced the usefulness of radiologic investigation in instances of spinal injuries [12]. One study highlighted the value of post-mortem computed tomography (PMCT) in the detection of injuries due to sharp trauma. However, it is limited principally to the detection of injuries to the vascular system. In one case, MSCT revealed an injury to cervical vessels, but could not precisely discriminate which vessels were injured [13]. Some studies suggest that PMCTA may overcome this difficulty and be used to depict vascular system injuries [14–16]. Our observations are consistent with this proposal. PMCTA enabled us to detect vascular injuries that would demand the use of specific techniques to be diagnosed by autopsy (i.e. the section of the right vertebral and the right deep cervical arteries and the section of the internal mammary vessels). Indeed, the use of different-time acquisitions was essential for the detection of the injured vessels (the right internal jugular vein). Moreover, exploration of the spinal cord is always a particular challenge on autopsy and dissection can be facilitated thanks to imaging. Finally, PMCTA permitted the illustration and documentation of injuries. 5. Conclusion Cases of spinal cord injury secondary to stab wounds are rare in the literature and classically victims survive and present neurological sequelae. This unusual homicidal case illustrates the value of PMCTA in cases of vascular injury. Such exploration is essential for the detection of the injured vessels.
References [1] INSERM, Centre d’e´pide´miologie sur les causes me´dicales de de´ce`s, INSERM, 2014. [2] V. Scolan, N. Telmon, A. Blanc, J. Allery, D. Charlet, D. Rouge, Homicide-suicide by stabbing study over 10 years in the Toulouse region, Am. J. Forensic Med. Pathol. 25 (2004) 33–36. [3] MMWR, National Violent Death Reporting System, 16 States, 2010, 2014. [4] F. De-Giorgio, M. Lodise, G. Quaranta, A.G. Spagnolo, E. d’Aloja, V.L. Pascali, V.M. Grassi, Suicidal or homicidal sharp force injuries? A review and critical analysis of the heterogeneity in the forensic literature, J. Forensic Sci. 60 (2015) S97–S107. [5] M. Oliver, K. Inaba, A. Tang, B.C. Branco, G. Barmparas, B. Schnu¨riger, T. Lustenberger, D. Demetriades, The changing epidemiology of spinal trauma: a 13-year review from a level I trauma centre, Inj. Int. J. Care Inj. 43 (2012) 1296–1300. [6] C. Palmiere, S. Binaghi, F. Doenz, P. Bize, C. Chevallier, P. Mangin, S. Grabherr, Detection of hemorrhage source: the diagnostic value of post-mortem CT-angiography, Forensic Sci. Int. 222 (2012) 33–39. [7] S. Grabherr, F. Doenz, B. Steger, R. Dirnhofer, A. Dominguez, B. Sollberger, E. Gygax, E. Rizzo, C. Chevallier, R. Meuli, P. Mangin, Multi-phase post-mortem CT angiography: development of a standardized protocol, Int. J. Leg. Med. 125 (2011) 791–802. [8] W.J. Peacock, R.D. Shrosbree, A.G. Key, A review of 450 stabwounds of the spinal cord, S. Afr. Med. J. 51 (1977) 961–964. [9] R. Lipschitz, Associated injuries and complications of stab wounds of the spinal cord, Paraplegia 5 (1967) 75–82. [10] R. Lipschitz, J. Block, Stab wounds of the spinal cord, Lancet 280 (1962) 169–172. [11] H.R. Saeidiborojeni, M. Moradinazar, S. Saeidiborojeni, A. Ahmadi, A survey on spinal cord injuries resulting from stabbings; a case series study of 12 years’ experience, J. Inj. Violence Res. 5 (2013) 70–74. [12] G. Rubin, D. Tallman, L. Sagan, M. Melgar, An unusual stab wound of the cervical spinal cord: a case report, Spine 26 (2001) 444–447. [13] J. Schnider, M.J. Thali, S. Ross, L. Oesterhelweg, D. Spendlove, S.A. Bolliger, Injuries due to sharp trauma detected by post-mortem multislice computed tomography (MSCT): a feasibility study, Leg. Med. 11 (2009) 4–9. [14] S. Grabherr, J. Grimm, A. Dominguez, J. Vanhaebost, P. Mangin, Advances in postmortem CT-angiography, Br. J. Radiol. 87 (2013) 20130488. [15] C. Jackowski, M.D. Sonnenschein, M.J. Thali, E. Aghayev, G. Von Allmen, K. Yen, R. Dirnhofer, P. Vock, Virtopsy: postmortem minimally invasive angiography using cross section techniques. Implementation and preliminary results, J. Forensic Sci. 50 (2005) 1175–1186. [16] F.Z. Mokrane, F. Savall, C. Re´rolle, A. Blanc, P. Saint Martin, H. Rousseau, D. Rouge, N. Telmon, F. Dedouit, The usefulness of post-mortem CT angiography in injuries caused by falling from considerable heights: three fatal cases, Diagn. Interv. Imaging 95 (2014) 1085–1090.
Contents lists available at ScienceDirect
Forensic Science International journal homepage: www.elsevier.com/locate/forsciint
Case report
An unusual homicidal stab wound of the cervical spinal cord: A single case examined by post-mortem computed tomography angiography (PMCTA) Frederic Savall a,*, Fabrice Dedouit a,b, Fatima-Zohra Mokrane b, Daniel Rouge´ a, Pauline Saint-Martin c, Norbert Telmon a a
Service de Me´decine Le´gale, Centre Hospitalier Universitaire Rangueil, Avenue du Professeur Jean Poulhe`s, 31403 Toulouse Cedex 4, France Service de Radiologie, Centre Hospitalier Universitaire Rangueil, Avenue du Professeur Jean Poulhe`s, 31403 Toulouse Cedex 4, France c Service de Me´decine Le´gale, Centre Hospitalier Universitaire Trousseau, Avenue de la Re´publique, 37170 Chambray-le`s-Tours, France b
A R T I C L E I N F O
A B S T R A C T
Article history: Received 11 May 2015 Received in revised form 12 June 2015 Accepted 26 June 2015 Available online 6 July 2015
We report an unusual case of homicidal stab wound of the cervical spinal cord, which illustrates the value of post-mortem computed tomography angiography (PMCTA) in cases of vascular injury. First, we noted a posterior and horizontal trajectory to the neck with complete section of the cervical spinal cord between the first and second cervical vertebrae. This lesion was accompanied by section of the right vertebral and right deep cervical arteries. We also noted an anterior cervical trajectory with an injury to the right internal jugular vein and an anterior right chest wound with a lung trajectory and section of the internal mammary vessels. Cases of spinal cord injuries secondary to stab wounds are rare in the literature. Only one large series has been published from Cape Town. Complete section of the cervical spinal cord accounts for only 4.5% of all cases. Furthermore, lethal cases are rare and classically victims survive and present neurological sequelae. We found only one similar case but despite the transection of the cervical spinal cord the patient survived. Some studies suggest that PMCTA may be very helpful in visualizing vascular system injuries. Our observations are consistent with this proposal. The use of different-time acquisitions was essential for detection of the injured vessels. ß 2015 Elsevier Ireland Ltd. All rights reserved.
Keywords: Cervical stab wound Spinal cord injury Post-mortem computed tomography angiography (PMCTA) Autopsy
1. Introduction In France, homicides by sharp instruments are as numerous as homicides by firearms, probably because there is strict firearms legislation (respectively 116 and 125 reported in 2010) [1,2]. In contrast, the same year, the United States’ National Violent Death Reporting System reported 2615 homicides by firearms and only 503 homicides by sharp instruments in 16 states [3]. In cases of homicide, sharp wounds to the neck are rare in the literature. In a recent review, the thorax was the most common site of injury, and the neck was involved in only 9.3% of cases [4]. In North America, between 1996 and 2008, spinal fracture represented 5.8% of the 44 455 patients of the Los Angeles County and University of Southern California Medical Centre and. 21.7% of patient with spinal fractures presented spinal cord injury. Penetrating injuries (gunshot wounds and stab wounds) were
* Corresponding author. Tel.: +033 05 61 32 28 59; fax: +033 05 61 32 21 77. E-mail address: [email protected] (F. Savall). http://dx.doi.org/10.1016/j.forsciint.2015.06.025 0379-0738/ß 2015 Elsevier Ireland Ltd. All rights reserved.
responsible for 14.1% of spinal injuries, with gunshot wounds accounting for a large population (86.5%) of these injuries. The most common causes of spinal injuries were motor vehicle accidents (32.6%) [5]. The recent use of post-mortem computed tomography angiography (PMCTA) offers the potential for analysis of cases of violent death by sharp instruments. Indeed, it could play a role in the detection of vascular and solid organ lesions [6]. We report an unusual case of homicidal stab wound of the cervical spinal cord, which illustrates the value of post-mortem computed tomography angiography (PMCTA) in cases of vascular injury. 2. Methods Before the PMCTA, the body was prepared by surgical cannulation of the femoral vessels (Maquet GmbH & co. KG, Rastatt, Germany). Prior to perfusion, toxicological samples (blood, bile, urine and hemothorax in our case) were collected. Following exploration, a controlled perfusion device (Virtangio1 machine)
F. Savall et al. / Forensic Science International 254 (2015) e18–e21
was used to administer paraffin oil mixed with special contrast agent (Angiofil1), allowing three different-time acquisitions: arterial, venous and dynamic (arterial injection with concomitant venous aspiration). The controlled perfusion machine (Virtangio, Fumedica AG, Muri, Switzerland) and the protocol used were developed by Grabherr et al. [7]. Two board-certified radiologists proceeded to analyze the images and two board-certified forensic pathologists performed an autopsy. The forensic pathologists conducting the autopsy were aware of the preliminary imaging results. 3. Case 3.1. Case history We report the case of a 26-year-old woman killed by her boyfriend in the context of separation. Her boyfriend was a butcher and he stabbed her several times with a chef’s knife (Fig. 1). 3.2. PMACT and autopsy findings The external examination revealed facial, cervical and thoracic stab wounds and defense stab wounds to the hands and forearms. At the cervical level, we noted two lesional trajectories. The first
e19
was located on the upper posterior part of the neck, with a horizontal trajectory, and complete transversal section of the cervical spinal cord, between the first and second cervical vertebrae (C1 and C2) (Fig. 2). This lesion was accompanied by section of the right vertebral and right deep cervical arteries (Fig. 3). The second lesion was anterior, located on the right side, at the base of the neck, and along its trajectory presented an injury of the right internal jugular vein, and section of the right transverse apophysis of the 7th cervical vertebrae (Fig. 4). We also noted two right cheek wounds with fractures of the mandible, one anterior right chest wound with a lung trajectory and section of the internal mammary vessels (Fig. 5), and one posterior right chest wound with one scapula bone lesion and a lung trajectory. Both chest trajectories had caused a major right pneumothorax and a hemothorax of 190 cm3. 4. Discussion Cases of spinal cord injuries secondary to stab wounds are rare in the literature. Only one large series has been published from Cape Town (South Africa). That study included 450 cases of stab wounds. Cervical spinal cord injury represented 29.5% of injuries but in most of these cases spinal cord injury was incomplete, and complete transection of the spinal cord was only found in 4.5% of all cases [8]. Furthermore, lethal cases are rare and classically
Fig. 1. The chef’s knife used.
Fig. 2. Posterior cervical trajectory. (A) Posterior cervical trajectory. (B) Section of the spinal cord between the first and second cervical vertebrae. (C) Post-mortem computed tomography: coronal view of the posterior cervical trajectory. (D) Post-mortem computed tomography: sagittal view of the vertebral canal. Section of the spinal cord between the first and second cervical vertebrae (arrowhead).
e20
F. Savall et al. / Forensic Science International 254 (2015) e18–e21
Fig. 3. Post-mortem computed tomography angiography: cervical arteries section. (A) Arterial phase: visualization of the left vertebral artery (arrow) and section of the right vertebral artery (circle). (B) Dynamic phase: section of the right deep cervical artery (arrowhead).
Fig. 4. Anterior cervical trajectory. (A) Injury of the right internal jugular vein (arrow). (B) Post-mortem computed tomography: axial view of the anterior cervical trajectory with a section of the right transverse apophysis of the 7th cervical vertebrae. (C) Venous phase of the post-mortem computed tomography angiography: injury of the right internal jugular vein (star).
victims survive and present neurological sequelae such as tetraplegia, paraplegia or Brown–Sequard syndrome [9,10]. In a case series study of 57 patients of the Taleqani Trauma Center (Kermanshah, Iran), only four patients died but 22 with paraplegia showed relatively complete recovery [11].
According to Lipschitz et al., the direction of the stab wound is classically upwards in the thoracic region and horizontal or downwards in the cervical region [9]. Peacock et al. highlighted that the high incidence of incomplete transection could be explained by the anatomy of the vertebral column. The transverse and spinous
F. Savall et al. / Forensic Science International 254 (2015) e18–e21
e21
Fig. 5. Anterior right chest trajectory. (A) Chest wound and lesional trajectory. (B) Arterial phase of the post-mortem computed tomography angiography: lung trajectory (arrow) and hemothorax (star). (C) Dynamic phase of the post-mortem computed tomography angiography: section of the internal mammary vessels (circle).
processes produce a gutter along which the blade would run before penetrating the spinal canal [8]. In our case, the horizontal trajectory in the cervical region permitted complete transection of the spinal cord between C1 and C2. We found only one similar case (i.e. horizontal trajectory and complete transection of the spinal cord between C1 and C2) in the literature. However, despite the transection of the cervical spinal cord the patient remained alive. In this case Rubin et al. enhanced the usefulness of radiologic investigation in instances of spinal injuries [12]. One study highlighted the value of post-mortem computed tomography (PMCT) in the detection of injuries due to sharp trauma. However, it is limited principally to the detection of injuries to the vascular system. In one case, MSCT revealed an injury to cervical vessels, but could not precisely discriminate which vessels were injured [13]. Some studies suggest that PMCTA may overcome this difficulty and be used to depict vascular system injuries [14–16]. Our observations are consistent with this proposal. PMCTA enabled us to detect vascular injuries that would demand the use of specific techniques to be diagnosed by autopsy (i.e. the section of the right vertebral and the right deep cervical arteries and the section of the internal mammary vessels). Indeed, the use of different-time acquisitions was essential for the detection of the injured vessels (the right internal jugular vein). Moreover, exploration of the spinal cord is always a particular challenge on autopsy and dissection can be facilitated thanks to imaging. Finally, PMCTA permitted the illustration and documentation of injuries. 5. Conclusion Cases of spinal cord injury secondary to stab wounds are rare in the literature and classically victims survive and present neurological sequelae. This unusual homicidal case illustrates the value of PMCTA in cases of vascular injury. Such exploration is essential for the detection of the injured vessels.
References [1] INSERM, Centre d’e´pide´miologie sur les causes me´dicales de de´ce`s, INSERM, 2014. [2] V. Scolan, N. Telmon, A. Blanc, J. Allery, D. Charlet, D. Rouge, Homicide-suicide by stabbing study over 10 years in the Toulouse region, Am. J. Forensic Med. Pathol. 25 (2004) 33–36. [3] MMWR, National Violent Death Reporting System, 16 States, 2010, 2014. [4] F. De-Giorgio, M. Lodise, G. Quaranta, A.G. Spagnolo, E. d’Aloja, V.L. Pascali, V.M. Grassi, Suicidal or homicidal sharp force injuries? A review and critical analysis of the heterogeneity in the forensic literature, J. Forensic Sci. 60 (2015) S97–S107. [5] M. Oliver, K. Inaba, A. Tang, B.C. Branco, G. Barmparas, B. Schnu¨riger, T. Lustenberger, D. Demetriades, The changing epidemiology of spinal trauma: a 13-year review from a level I trauma centre, Inj. Int. J. Care Inj. 43 (2012) 1296–1300. [6] C. Palmiere, S. Binaghi, F. Doenz, P. Bize, C. Chevallier, P. Mangin, S. Grabherr, Detection of hemorrhage source: the diagnostic value of post-mortem CT-angiography, Forensic Sci. Int. 222 (2012) 33–39. [7] S. Grabherr, F. Doenz, B. Steger, R. Dirnhofer, A. Dominguez, B. Sollberger, E. Gygax, E. Rizzo, C. Chevallier, R. Meuli, P. Mangin, Multi-phase post-mortem CT angiography: development of a standardized protocol, Int. J. Leg. Med. 125 (2011) 791–802. [8] W.J. Peacock, R.D. Shrosbree, A.G. Key, A review of 450 stabwounds of the spinal cord, S. Afr. Med. J. 51 (1977) 961–964. [9] R. Lipschitz, Associated injuries and complications of stab wounds of the spinal cord, Paraplegia 5 (1967) 75–82. [10] R. Lipschitz, J. Block, Stab wounds of the spinal cord, Lancet 280 (1962) 169–172. [11] H.R. Saeidiborojeni, M. Moradinazar, S. Saeidiborojeni, A. Ahmadi, A survey on spinal cord injuries resulting from stabbings; a case series study of 12 years’ experience, J. Inj. Violence Res. 5 (2013) 70–74. [12] G. Rubin, D. Tallman, L. Sagan, M. Melgar, An unusual stab wound of the cervical spinal cord: a case report, Spine 26 (2001) 444–447. [13] J. Schnider, M.J. Thali, S. Ross, L. Oesterhelweg, D. Spendlove, S.A. Bolliger, Injuries due to sharp trauma detected by post-mortem multislice computed tomography (MSCT): a feasibility study, Leg. Med. 11 (2009) 4–9. [14] S. Grabherr, J. Grimm, A. Dominguez, J. Vanhaebost, P. Mangin, Advances in postmortem CT-angiography, Br. J. Radiol. 87 (2013) 20130488. [15] C. Jackowski, M.D. Sonnenschein, M.J. Thali, E. Aghayev, G. Von Allmen, K. Yen, R. Dirnhofer, P. Vock, Virtopsy: postmortem minimally invasive angiography using cross section techniques. Implementation and preliminary results, J. Forensic Sci. 50 (2005) 1175–1186. [16] F.Z. Mokrane, F. Savall, C. Re´rolle, A. Blanc, P. Saint Martin, H. Rousseau, D. Rouge, N. Telmon, F. Dedouit, The usefulness of post-mortem CT angiography in injuries caused by falling from considerable heights: three fatal cases, Diagn. Interv. Imaging 95 (2014) 1085–1090.
