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Dating of Gunshot Wounds

Injuries in living victims must be distinguished from postmortem injuries (vital versus postmortem injuries). If an injury occurs shortly after cardiac arrest, it can be extraordinarily difficult to make a differentiation: the hallmark can be the lack of significant bleeding. If bleeding has occurred and/or if there is a zone of hemorrhage and/or edema around the permanent missile track, postmortem injury is unlikely (Oehmichen 1992).

Reliable criteria for the vitality of a wound are the reactive changes associated with life (cf. Oehmi-

chen et al. 1985, 2001). The emigration of leukocytes can be noted after survival times <70 min (maybe >10 min - see below, pp. 190 ff), and expression of P-amyloid precursor protein after survival times >105 min (Blumbergs et al. 1995). Further criteria of vitality are the development of a perifocal edema, i.e., perineuronal and perivascular vacuolization. The temporal sequence of these edematous changes cannot be reliably established since they depend on a number of variables such as blood pressure, the extent of primary and secondary hypoxic changes, whether intoxication has occurred, etc. The first signs of edema may appear after survival times >20-30 min.

Fig. 8.17a-e. Differentiation of entrance and exit wound based on the bony structures found at autopsy (a, c) and on CT 3D reconstruction of cranial surfaces (b, d). A smooth-surfaced, bony defect appears to have been punched out of the interior of the skull at the entrance wound (a, b); bone fragments have broken off to form a funnel-shaped bone defect on the outside of the skull at the exit wound (c, d). Bone fragments in the interior of the skull are more densely grouped the nearer they are to the entrance wound (e). (CTComputed tomography.) (cf. Oehmichen et al. 2003)

Fig. 8.17a-e. Differentiation of entrance and exit wound based on the bony structures found at autopsy (a, c) and on CT 3D reconstruction of cranial surfaces (b, d). A smooth-surfaced, bony defect appears to have been punched out of the interior of the skull at the entrance wound (a, b); bone fragments have broken off to form a funnel-shaped bone defect on the outside of the skull at the exit wound (c, d). Bone fragments in the interior of the skull are more densely grouped the nearer they are to the entrance wound (e). (CTComputed tomography.) (cf. Oehmichen et al. 2003)

The following histomorphological criteria have been determined for different lengths of posttrau-matic survival intervals (Oehmichen 1992): (1) nerve cell shrinkage (30 min-62 h), (2) nerve cell vacuolization (30 min-62 h), (3) perineuronal vacuolization (30 min-62 h), (4) white matter edema (50 min-62 h), (5) oligodendroglial swelling (90 min-62 h), (6) leukocyte emigration (70 min-62 h), (7) macrophage reaction (17-62 h), (8) erythrocyte-containing macrophages (19-62 h), (9) neuronophagia (19-62 h).

These observations are based on a relatively small number of cases (n=17), since gunshot injuries of the brain under non-war conditions are only rarely survived and the exact time of death - especially in cases of suicide - is usually impossible to determine. The above observations however are in accordance with the findings of other authors (cf. Rand and Courville 1934; Campbell and Kuhlenbeck 1950; Campbell et al. 1958).

Fig. 8.18a, b. Demonstration of the missile track within the brain lin-fixed brain (a) and after CT imaging of the whole formalin-parenchyma by macroscopic inspection of the sectioned, forma- fixed brain (b)

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