The focus is on unnatural death in forensic pathology including criminal death. One special field is the murder-suicide or homicide-suicide. It is a relatively rare occurrence worldwide mainly with male perpetrators and female victims. The authors report a case about a special type of homicide-suicide which is so-called intimate partner homicide (femicide)-suicide in which the victim was a 42-year-old woman with more than 55 incised- (cuts, stabs, etc.) and blunt force injuries with external examination. The resuscitation was unsuccessful by the paramedics. Not one of the wounds was incompatible with life, some of them had life-threatening conditions, and numerous self-defense type of wounds were observed. Not so far from the crime scene, the 48-year-old perpetrator's hanging corpse was found on a high voltage electric column who previously committed suicide, talked to one of his daughters from his first marriage, left money at his funeral, and asserted he would not have gone to prison again. The authors compared this case with the international literature data.

Background: Fat embolism and fat embolism syndrome are rare but well-known consequences of long bone fractures and orthopedic surgeries. These sources support the mechanical theory of their development. On the other hand, as an alternative pathway suggested by the biochemical theory, lipase activation and fat breakdown are also a possible background for lipid droplets appearing in the vasculature. According to Hulman’s theory, elevated C-reactive protein levels can facilitate calcium-dependent agglutination of very low-density proteins and chylomicrons forming fat globules. The level of this acute-phase protein can increase mainly in advanced-stage cancers but also has predictive or indicative value in treatment success. Methods: This study focused on strictly selected patients with different histological types and origins of cancer, as well as advanced cancer in approximately 90% of the deceased. After collecting the tissue samples, the frozen sections were stained with Oil Red O to detect fat emboli. Results: Less than 50% of the cases showed punctiform, non-clinically relevant pulmonary fat embolism, and fat embolism syndrome was identified in none of the cases. In one, non-advanced cancer case, punctiform kidney fat embolism was observed. Conclusions: The end-of-life anergic state of patients may influence the procedure. In the case of osseous metastases, since the intramedullary sinuses are affected, both the mechanical and the biochemical backgrounds may prevail and mediate fat embolism formation.

Background: Fat embolism frequently occurs as a result of trauma, such as long bone fractures and orthopedic surgeries, as well as in certain non-traumatic conditions. The formation can be attributed to mechanical or biochemical processes. According to Hullman’s biochemical hypothesis, elevated C-reactive protein levels facilitate the precipitation of very-low-density lipoproteins and chylomicrons, forming fat globules that may result in fat embolism. Based on the abovementioned hypothesis, this study aims to detect fat embolism in autopsy patients (postmortem) suffering from bronchopneumonia and determine its possible role as a cause of death. Methods: A group of autopsies of deceased individuals with bacterial purulent bronchopneumonia with confirmed or presumed elevated C-reactive protein levels was rigorously selected, excluding those with other potential causes of fat embolism such as cardiopulmonary resuscitation, hypothermia, and diabetes mellitus. Multiple organs were sampled for frozen section analysis using Oil Red O fat staining and assessed for the presence and extent of fat embolism. The Falzi score, as modified by Janssen, was employed for the lung tissue. Results: In 73% of the cases, predominantly sporadic, Grade 0 or Grade I fat embolism was observed; however, in none of the cases was fat embolism identified as the cause of death or as a significant contributing factor. Furthermore, neither fat embolism syndrome nor multiorgan fat embolism were detected. Conclusions: Although an elevated C-reactive protein level facilitates the formation of fat globules and fat embolism, its role as a direct cause of mortality remains uncertain. It may predispose individuals to such conditions and potentially interact with other factors, such as minor soft tissue trauma, to exacerbate the severity of fat embolism or its clinical manifestations. These findings underscore the necessity for further comprehensive investigations within the contexts of infection/inflammation, fat embolism, and dyslipidemia.

The authors report a case of fatal postpartum acute subdural hematoma after multiple attempts at spinal anesthesia related to cesarean delivery. A 22-year-old primigravida was admitted to the Obstetrics and Gynecology Department due to the throes of childbirth. The presence of threatening intrauterine hypoxia indicated a C-section with the usual lumbar anesthesia. However, the anesthesia proved insufficient, necessitating the administration of intratracheal narcosis, which occurred without complication. A healthy, mature boy was born with Apgar scores of 10/1 and 10/5. During the first 8 h of the postpartum period, the primipara exhibited stable vital parameters without neurological symptoms. After 8.5 h, a grand mal seizure was observed following a period of consciousness and spontaneous breathing that soon ceased. The CT scan examination revealed a significant left fronto-temporo-parietal acute subdural hematoma. All brainstem reflexes were absent, lacking corneal, trigemino-facial, and oculo-vestibular reflexes, with submaximal dilated pupils, and unresponsive to direct and consensual light stimuli. Despite an urgent neurosurgery operation and 4 days of intensive therapy, follow-up brain CT examinations showed a massive midline shift and compression of the supratentorial ventricle system. No trauma or other malformations of the brain were detected. According to the primary brain damage protocol, after a 12-hour observation period, brain death was declared, and she was deemed suitable for organ donation. Our mini-review identified 12 published cases of postpartum subdural hematoma following spinal anesthesia between 1995 and 2021. The data highlight the importance of early neuroimaging and multidisciplinary assessment when postpartum headaches or seizures occur.