Unexpected Death Following Single Blow to the OrbitCarson, Henry J. MDAmerican Journal of Forensic Medicine & Pathology: December 2010 - Volume 31 - Issue 4 - pp 370-372 doi: 10.1097/PAF.0b013e3181d3dbd7 Case Reports Abstract Author Information Severe brain injury is rare after assault to the head with a fist. Our patient was a 39-year-old white male who was punched in a parking lot. The subject fell on his right head. He did not lose consciousness. The subject was taken to the hospital. On admission, his blood alcohol concentration was 229 mg/dL. A CT scan of the head showed no injury. He was admitted to the detoxification unit. He became sober, and was seen ambulating at 3:30 am. By 5:20 am, he was unresponsive. A CT scan of the head showed that an epidural hematoma had developed over the right temporal lobe. The hematoma was drained. The patient did not recover. EEG confirmed no cerebral activity. At autopsy, the brain was removed, showing that the central brain was liquefied. The skull demonstrated a hairline fracture of the right temporal bone, corresponding to the impact with the sidewalk. Our patient differs from the typical victim of head trauma from assault in that severe brain injury or death is typically rare in assault. Alcohol is reported sometimes to have a neuroprotective effect in head injury. The present case illustrates an extreme conclusion of an otherwise-routine head trauma. From the Linn County Medical Examiner"s Office, Cedar Rapids, IA. Manuscript received December 30, 2008; accepted March 18, 2009. Reprints: Henry J. Carson, MD, 3810 Cedar Bluff Court NE, Cedar Rapids IA 52411. E-mail: firstname.lastname@example.org. © 2010 Lippincott Williams & Wilkins, Inc.