Fall downstairs: accident, homicide or natural death?

In homicide cases a clear anatomical or toxicological cause of death is normally evident. In the following a case is described where, without clear anatomical or toxicological cause of death, the husband of the deceased—a trained anaesthesiologist—was charged with murder. Suspicion was raised since the autopsy findings did not correspond to a fatal fall downstairs but instead could be definitely ruled out as cause of death, since intracranial bleedings and cerebral contusions, the leading causes of death in fatal falls downstairs, were missing. Further suspicion was raised since electrocardiograms (ECGs), previously stated by the accused to have been recorded personally from his wife during cardiopulmonary resuscitation (CPR), were obviously faked. Additionally, an ampule of succinylcholine was missing from his emergency case. In a trial lasting more than three quarters of a year with several witnesses and experts heard by the court, the cause of death remained unclear. However, a natural cause of death and a fatal fall downstairs were ruled out. Subsequently the husband admitted during the trial to have killed his wife without elaborating on the circumstances for legal reasons. He was sentenced to prolonged imprisonment. Of special importance was that, based on the knowledge of typical autopsy findings in fatal falls downstairs, a lethal fall downstairs could be ruled out. Therefore even negative autopsy findings are of great forensic importance.