Scissors stab wound to the cervical spinal cord at the craniocervical junction

A rare case of respiratory failure associated with spinal cord injury caused by stabbing with scissors and a knife

In forensic practice, spinal cord injury (SCI) resulting in death has rarely been reported. Here, we present the case of a 65-year-old woman who on admission was conscious without dyspnea or dysphagia. Physical examination revealed two sharp objects penetrating the neck: a pair of scissors lodged in the neck on the right side of the thyroid cartilage and a knife embedded in the nuchal region accompanied by minor seepage of bloody exudate. Radiography showed that the scissors and knife were retained in the cervical spine. Despite a series of medical interventions, the patient died 26 days later.

METHOD

A systematic forensic autopsy was performed.

RESULTS

The cause of death was confirmed to be respiratory failure associated with SCI, which was caused by the combination of scissors and a knife.

CONCLUSION

Based on this case, we believe that when there are multiple causes of death, forensic pathologists should determine the primary, immediate, contributory, and other causes of death to ascertain criminal responsibility.

Conservative Management of Traumatic Brown-Séquard Syndrome: A Case Report

Patient: Male, 33-year-old

Final Diagnosis: Traumatic Brown-Séquard syndrome

Symptoms: Bilateral lower limb weakness • contralateral (right) hypoesthesia from the level of the nipple below • knee and ankle jerks both were 2 on the right side and 0 on the left

Medication: —

Clinical Procedure: Magnetic resonance imaging (MRI) of the cervical and thoracic spine • whole-body computed tomography (CT)

Specialty: Surgery

Traumatic Brown-Séquard syndrome: modern reminder of a neurological injury

Brown-Séquard syndrome (BSS) presents as an ipsilateral loss of motor function, proprioception and vibratory sensation accompanied by contralateral pain and temperature loss two to three levels below the level of the injury. It is one of the syndromes associated with incomplete transection of the spinal cord. Classic BSS is rare as most patients present with mixed neurological deficits related to damage of the spinal cord and surrounding structures. BSS remains prevalent in areas with high trauma burden, where assaults with sharp weapons are common. We present the case of a man aged 38 years who sustained a stab injury to the left back. BSS was diagnosed. He underwent removal of the weapon in the operating room and had an uneventful recovery to near baseline functional level after a course of rehabilitation. Despite being a rare aetiology, BSS continues to be an excellent reminder to trauma providers of the anatomy and physiology of neuroanatomical tracts.

Stabbing Injury of the Cervical Spinal Cord Resulting in Complete Loss of Bilateral Proprioception

BACKGROUND

Direct penetrating trauma to the spinal cord as a result of stabbing is rare. The vertebral column is strongly suited to protecting the vital neural structures underneath, especially in the midline.

CASE DESCRIPTION

A 25-year-old woman experienced a direct stabbing injury to her spinal cord, through the midline structures, resulting in bilateral dorsal column injury. She remained intact with regard to motor function despite bilateral sensory and proprioception loss.

CONCLUSIONS

Owing to the strength of the protective elements of the osseous structures surrounding the spinal cord, direct stabbing injuries usually result in incomplete neurologic deficits. This is generally manifested as a Brown-Sequard syndrome because of the midline ligamentous structures and spinous processes deflecting injuries laterally. Our patient experienced a direct midline puncture, resulting in a unique case of bilateral dorsal column injury. These injuries are generally treated conservatively, in the absence of a retained foreign body. Spinal cord stabbing injuries are a rare entity with interesting clinical and anatomic correlations.

The transfer of fibres via weapons from garments

Stabbings have been reported as the most frequent violent crime in countries where there is a severe restriction on obtaining firearms, such as the United Kingdom. Knives, scissors, and screwdrivers, as studied in this research, are among the most commonly encountered weapons involving stabbing events. When any of these implements are used in a stabbing, there is potential for the garment(s) worn by the victim to be damaged. In such an instance, there is an opportunity for fibres to be transferred to the weapon used, thus providing forensic evidence of proof of transfer from the victim's clothing to the weapon. This can offer valuable information in establishing what weapon was used to harm the victim through linking fibres from the victim's garment(s) to a weapon recovered from a suspect. This research simulates vertical stabbings - performed by a human participant - in to a polystyrene block supporting the clothing (essentially acting as the victim's torso), to reflect an authentic scenario. The aforementioned weapons were used along with 3 varieties of garments (cotton, polyester and a linen/viscose mix) offering different characteristics of shedability and structure for the simulated stabbings. Low power microscopy was utilised to view the transferred fibres. The amount of fibres transferred on to the implement were recorded for each repeat. 2279 individual fibres were found over 10 repeats from the knife in relation to the linen/viscose garment. This was the highest amount of transference found with the lowest number attributed to the screwdriver-polyester relationship, providing 320 recorded fibres over 10 repeats. The findings of this study suggest that the number of fibres transferred is not only related to the shedability of the garment but also the surface area characteristics of the receiving weapon and the ability for the garment to tear.