An Unusual Death From Penetrating Cranial Trauma: The Importance of Investigating the Primary Scene of Injury.

A 65-year-old man with a history of hypertension and coronary artery disease was found dead at home after having fallen about 6 days prior. Autopsy examination revealed unexplained penetrating trauma of the skull with a circular defect in the frontal bone with associated cerebral laceration and organizing subdural hemorrhage. As the cause of the penetrating injury was unknown, the forensic pathologist instigated further investigation. Through interviews, the medicolegal death investigator identified the primary scene of injury, which was different from the scene of death; she elucidated the injury scenario, including the culprit object, which she photographed during the follow-up investigation. The etiology of the injury allowed the medical examiner to correctly certify manner of death. This case represents an interesting example of penetrating cranial injury, with minimal external injury and extensive internal lethal damage to the brain. Furthermore, it highlights the importance of investigating the primary scene of injury, especially when death is delayed and the deceased is no longer at the injury location.