Summary
Introduction. Suicide by firearm is the second most common method of suicide in Lithuania after strangulation with a noose. Suicides with multiple gunshot wounds to the head are unusual due to lethality of massive central nervous system injuries – usually, more than one gunshot wound is indicative of a homicide. Forensic examination is the most important step in differentiating suicide from homicide, allowing assessment of the injuries and possible circumstances of their occurrence.
Case report. This clinical case concerns a 68-year-old man, whose body was discovered in his home with multiple gunshot wounds in the head. Life anamnesis includes Stage III prostate cancer. A computed tomography (CT) examination of the head was performed; the reconstructions were insufficient to determine the sequence and direction of the injuries. Two close-range gunshot injuries were found, as indicated by traces of soot and metallization were found at entrance wounds, and star-shaped cracks around edges of injuries caused by impact of discharge gasses. The first wound channel traveled through the facial bones without damaging the structure of the brain. The second projectile caused damage to the brain and was fatal.
Conclusions. Morphology of the injuries meets criteria of suicide and explain how the person was able to remain conscious and act after the first shot – the projectile was fired in an unusual direction, i.e., to the lower surface of the chin, which led to the trajectory which did not damage the structure of the brain. CT is a useful method for reconstructing the image of injuries and providing preliminary information about entrance and exit wounds and their channels, but it cannot replace autopsy as the trajectory of the injuries is determined inaccurately.
