Sudden death after psychophysical stress: autopsy on trial

The association between stressful and cardiac events is well known in clinical literature but, in many cases, autopsy fails to identify the etiopathogenic mechanism that leads to death, especially when several possible causes occur (even traumatic ones), each potentially and equally preponderant on the cause of death. We discuss here a forensic and juridical case of a 48-year-old man (alcohol and drug addicted, affected by chronic viral hepatitis and heart disease) who died suddenly after being hit on the head by his father with a meat tenderizer where autopsy found no fatal traumatic injuries. This case is used as an opportunity to review both clinical and forensic literature of sudden death after psychophysical stress, focusing on the role of autopsy. Determination of a causal link between a stressful event and sudden death is an important step in the certification of the manner of death. Cases of such complexity always require complete autopsy, including at least histology, and toxicology, to confirm or exclude the scientific sustainability of the prior hypothesis, based on medical and circumstantial history.