Head Trauma and Alcohol: A Lethal Combination.

There has been much recent attention regarding "concussions" and the role they may play in death. As most medical professionals are aware, concussions exist on a spectrum ranging from minimal or no loss of consciousness with no residual sequelae to diffuse axonal injury and sudden death. The location on the spectrum depends not only on the nature of the impact or blow but also on the state of the individual impacted. Three previous reports have illustrated 7 deaths due to blunt force head trauma with acute ethanol intoxication (postconcussive apnea). The present report describes 6 additional deaths, five of which were witnessed. The report discusses the pathophysiology of postconcussive apnea and concludes that the head trauma results in a concussion, which when combined with the ethanol, results in prolonged apnea by disruption of the cardiorespiratory centers leading to death. In addition, it is concluded that individuals dying from postconcussive apnea become immediately unresponsive after the head trauma, demonstrate no significant anatomic abnormalities at autopsy, and have blood ethanol concentrations ranging from 0.168 to 0.33 g/dL (mean, 0.258 g/dL; median, 0.24 g/dL).