Crossbow suicide: Mechanisms of injury and neuropathologic findings

Crossbow injuries are rarely reported events in modern times. Two cases of death due to self-inflicted crossbow injuries to the head are reported in 2 men aged 18 and 27 years, respectively. Despite relatively low velocity an d concussive force, the sharpness and propulsion force of crossbow bolts ma y be sufficient to enable penetration of the skull at short range. Due to t he relatively low concussive force of the crossbow bolt, however, death may not be instantaneous but may occur from intraparenchymal cerebral damage s ometime thereafter. Detailed neuropathologic evaluation of such cases may t herefore demonstrate "red cell" hypoxic injury, as well as axonal injury, n ot limited to the region of the missile tract, but widely distributed, even to the point of extensive brain stem involvement. These changes may result from primary mechanical deformation at the time of injury, from secondary hypoxic damage, or from a combination of both factors. Immunohistochemical staining of brains for amyloid precursor protein to delineate more clearly the pattern of axonal damage may assist in determining the extent of injury in such cases.