Hg. Mirchandani et al., COCAINE-INDUCED AGITATED DELIRIUM, FORCEFUL STRUGGLE, AND MINOR HEAD-INJURY - A FURTHER DEFINITION OF SUDDEN-DEATH DURING RESTRAINT, The American journal of forensic medicine and pathology, 15(2), 1994, pp. 95-99
Four cases from the Philadelphia Medical Examiner's Office are present
ed and the literature is reviewed to define further the syndrome of su
dden death occurring during cocaine-induced-agitated delirium and stru
ggle during restraint in individuals who also sustain minor head injur
y. The mechanism of death involves a terminal arrhythmia, most likely
due to sympathetic sensitization of the myocardium by cocaine and the
stress of struggle sometimes juxtaposed upon the stratum of minimal na
tural disease. In the cases described, the head injury in itself was i
nsufficient to be a cause of death. Recognition of the role of the pha
rmacologic effect of cocaine and the lethal effects of its use in this
setting is crucial.