2. An unusual death due to the impalement of a gear stick into the brain stem through the nasal cavity: a case report.

A 59-year-old male was driving a car on the road and was involved in a traffic accident, colliding with a tanker and a big lorry. When an ambulance arrived at the scene, he was in a state of cardiopulmonary arrest and was bleeding profusely from his right nostril. He was confirmed dead at hospital. The autopsy showed a laceration of the right upper lip extending to the right nostril. In the basal skull there was a notable perforation at the ethmoid bone together with the central part of the sphenoid bone including the sella turcica. In accordance with the basal skull bone fractures, there were pronounced contusion injuries at the brain stem and a contusion injury was also observed in the right part of the cerebellum. After careful investigation of a causative stick-like item that was present inside the car, it was concluded that a severe movement of the man's body, as a result of the traffic collision, caused the gear stick which was fixed to the steering wheel to become impaled in the man's right nostril. The gear stick passed through the nasal cavity and into the basal skull bones, resulting in fatal brain stem injuries.