A Fatal Contact Occipital Gunshot Wound with Transforaminal Projectile Passage and Cervical Spinal Canal Lodgment at C1: Scene, Radiologic, and Autopsy Correlation

Fatal gunshot wounds to the head commonly result in projectile exit or intracranial retention. Transforaminal projectile passage into the cervical spinal canal represents an uncommon ballistic trajectory that may complicate wound-track reconstruction and medicolegal interpretation. We report the case of a 59-year-old male found deceased inside a parked vehicle following an alleged self-inflicted firearm injury. External examination revealed a single contact-range stellate entry wound located at the upper midline occipital region, with no exit wound identified. Postmortem radiologic examination localized a single retained projectile within the upper cervical region at the C1 level. Autopsy demonstrated an inward-beveled occipital bone defect with a downward wound trajectory, severe craniocerebral injury, and transforaminal passage through the foramen magnum, with terminal lodgment of the projectile within the cervical spinal canal accompanied by hemorrhagic infiltration. No additional traumatic injuries suggestive of interpersonal violence were identified. Toxicological analysis was negative for alcohol and screened for drugs of abuse and commonly tested pharmaceuticals. Integrated correlation of scene findings, postmortem imaging, and autopsy examination was essential for accurate reconstruction of this atypical ballistic pathway. The case underscores the diagnostic value of targeted craniocervical evaluation in cranial gunshot wounds lacking an exit wound and highlights the role of postmortem imaging in guiding focused dissection and evidence recovery. This case documents a rare fatal occipital gunshot wound with transforaminal projectile passage and cervical spinal canal lodgment at C1. Awareness of this unusual trajectory pattern is critical for forensic pathologists to ensure complete wound-track reconstruction and accurate medicolegal determination.