Case report of sudden death after a blow to the back of the neck

A 13-year-old girl experienced a fall during gym class that caused immediat e unresponsiveness and death. The lone witness reported that the decedent l ost her balance as she approached a hurdle and fell, striking her head on a crossbar of the hurdle near the ground. Autopsy revealed no external injur y. Internal injury that could be demonstrated anatomically was confined to a contusion within the right semicapitis muscle at the base of the skull. I n the absence of an anatomic cause of death, possible explanations of the d eath include a cardiac dysrhythmia, a vasovagal stimulus, and diffuse axona l injury caused by a concussive force to the junction of the medulla and sp inal cord. Animal studies have shown that severe concussion can cause death via profound autonomic dysfunction without leaving anatomic evidence of in jury, and that the essential component of concussion is an element of rotat ional injury to the brain. The authors believe that the blow to the neck ca used this death by the transmission of a concussive force through the retic ular activating system. The prompt work of police in distinguishing the Zon e witness from several people in the area who thought they knew what had ha ppened was essential for diagnosis. On reaching our conclusions, the author s notified first the family, then the superintendent of the school system, and finally the news media. The authors told each party in turn that they w ould be contacting the others.