Foreign body penetration of the fontanelle: mechanisms and manner of death.

Penetrating injuries of the anterior fontanelle are exceedingly uncommon and are most often associated with inflicted injury. This report of an 11-month-old boy, who fell backward onto a lamp-shade strut that penetrated his anterior fontanelle and left frontal lobe, demonstrates that accidental injuries may also rarely occur. Death was due to hypoxic-ischemic encephalopathy complicating raised intracranial pressure after a penetrating injury of the brain. Careful evaluation of the death scene with reconstruction incorporating the autopsy findings was required to establish the veracity of the history and the credibility of the proposed sequence of events. Mechanisms of death after penetrating injuries of the fontanelle include immediate effects from direct damage to cerebral vital structures or blood vessels with hemorrhage or delayed effects from either cerebral edema with hypoxic-ischemic encephalopathy or sepsis.