Jun 29 2012

Causeway Killer Mystery

I wrote previously about the case of Rudy Eugene, the “Causeway Cannibal” who was found by police naked chewing on the face of a homeless man. At the time I felt the most plausible hypothesis for this bizarre and violent behavior was drugs, especially given that Eugene had no history of violence. It was therefore a little surprising when the official toxicology report came out Wednesday showing only marijuana in Eugene’s system, and no other known street or prescription psychoactive drugs – no LSD, bath salts, cocaine, narcotics, benzodiazepines, or barbiturates.

So what are we to make of this? We now have a neuropsychiatric mystery – what can cause a man with no history of violence to do what Eugene did. According to reports he parked his car on the beach, then walked back to Miami, stripping off his clothes along the way. He had his bible with him and he tore out pages leaving them along the road as well. At one point he was seen swinging naked from a light post. He then came upon Ronald Poppo, subdued him, tore off his clothes, and then proceeded to chew off his face (but not swallow the tissue). When confronted by an armed police officer Eugene refused to stop his behavior and was then shot four times until he was dead.

If we treat this as a medical history, then what is our differential diagnosis? Before we discuss cause (etiology) we should discuss phenomenology – what kind of behavior is this?  There are two phenomena to consider, psychosis vs delerium. Delerium or encephalopathy refers to an acute process that causes the higher cognitive functions of the brain to be compromised leading to a “clouded sensorium,” meaning that the person has difficulty attending to sensory information. They interact intermittently with their environment and usually also have a waxing and waning level of consciousness. They are confused as to their situation. They may hallucinate, and may become violent, but that violence is usually not directed or purposeful, just a non-specific lashing out at things around them.

The reports and video of Eugene’s behavior do not fit very well with encephalopathy. I can’t say it is impossible, but the purposeful and bizarre violence is atypical. Neurological events (such as a seizure, stroke, amnestic episode, or metabolic derangement) would cause a delirium rather than psychosis.

This episode fits better with psychosis, in which bizarre behavior is typical. Those suffering from a psychotic break may be alert and purposeful and able to interact with their environment, but have an acute thought disorder. Hallucinations (both audio and visual) are common, as are delusions, which may be elaborate and are often paranoid in nature. Directed violence is definitely possible.

Given the descriptions of the behavior that we have, I strongly lean towards psychosis as the phenomenon, rather than delirium. What, then, can cause psychosis?

There are two main causes of psychosis to consider, a psychiatric illness or drug induced. Those with schizophrenia, for example, can have episodes of rapid and severe worsening where they have a “psychotic break” and can engage in extreme bizarre and violent behavior. Such psychotic episodes can be spontaneous or triggered, by going off of anti-psychotic medication, using recreational drugs, or a psychological stressor.

I have not been able to find any definitive information about Eugene’s psychiatric history, but in the interviews with those who knew him there is no discussion of any significant psychiatric history or diagnosis, and no prior episodes of violence, hallucinations, delusions, or psychotic breaks. Now we also have a toxicology report that is completely negative – so there does not appear to be any data supporting either main cause of a psychotic episode. Where does that leave us?

I see several possibilities. The first is that Eugene did have a psychotic disorder, but was generally high functioning and just did not have any prior dramatic episodes (at least that we know about). This simply could have been his first major psychotic episode. He was 31 years old, which is a little old for a first episode but within the range that is seen. At this point the only way to determine if this was the case is for a psychiatrist to take a careful history from his friends and family in search of more subtle signs of a prior psychotic illness that was simmering in the background. However, now that Eugene is dead it is not likely that a definitive answer can be had.

The other possibility is that Eugene (with or without an underlying tendency for psychosis) did use a street drug that triggered an acute psychotic episode. The toxicology can only test for known substances, but the purpose of designer street drugs is to keep one step ahead of regulation by frequently coming out with new chemicals. Obviously it’s hard to prove that Eugene did not have an unknown drug in his system, but it’s important to recognize that this has not been ruled out by the toxicology. I hope they kept sufficient tissue samples of Eugene so that if new street drugs come to light in the near future they can go back and test him for it.

The toxicology did find marijuana in his system. This is certainly not a typical episode from just marijuana use, but I guess a third possibility (but I would say far less likely) is that Eugene had an atypical response to marijuana (which can rarely occur).

Conclusion

The cause of the Causeway Killer’s (or Cannibal, depending on your preference) behavior may never be known, but I think I covered all the plausible possibilities above. Of course there are an unlimited number of implausible possibilities – alien mind control, an unknown zombie virus, demonic possession, evil fairies, vampirism, etc. I do hope the authorities will continue to pursue an answer, which may turn out to be very informative.

Share

26 responses so far

26 Responses to “Causeway Killer Mystery”

  1. locutusbrgon 29 Jun 2012 at 8:48 am

    In my prior history in the ER, which is admittedly a little dated. There are several hallucinogens that have no specific test. There are also some street drugs that have such a short half life that detectable levels often disappear while they are symptomatic. A reasonable hypothesis as Steve suggested is an earlier dosage of a drug induced a psychotic episode for an underlying disorder.

    Otherwise I favor Zombie Apocalypse cover-up.

  2. SARAon 29 Jun 2012 at 9:14 am

    When I read this I wondered if he could have had a reaction to something toxic on the marijuana. A fertilizer or weed killer or even some drugs that were processed near the marijuana.

  3. pmlyonon 29 Jun 2012 at 9:17 am

    Why did they think it was bath salts in the first place?

  4. curt1313on 29 Jun 2012 at 10:22 am

    Could the marijuana have triggered some sort of latent psychotic disorder?

  5. Steven Novellaon 29 Jun 2012 at 11:20 am

    Because some drugs sold as bath salts can cause psychotic episodes and also increased body temperature, which might have explained why he took off his clothes. Also I think the police have just been encountering it in the area.

  6. daedalus2uon 29 Jun 2012 at 12:17 pm

    I suspect mitochondrial uncoupling. I think that is the final common pathway in many of the things that cause psychosis and which also cause hyperthermia. There are pathways that trigger mitochondrial uncoupling and dissipate mitochondrial potential as heat.

    They could measure the respiration ability of his mitochondria, mitochondria will survive for days or even perhaps weeks following death, but not if mitochondria uncoupling has been triggered. I would expect to see muscle damage, elevated lactate dehydrogenase, perhaps myoglobin in the blood and other signs of rhabdomyolysis.

    https://en.wikipedia.org/wiki/Rhabdomyolysis

    Many things will trigger mitochondrial uncoupling, huffing solvents will, many drugs will, many inhalation anesthetics will. Fight-or-flight can trigger it all by itself. It is a “feature”, if you are in fight-or-flight and need to run from a bear, it is better to ramp up muscle mitochondria as high as they will go and dissipate the energy as heat, to reduce the delay if you need a burst of speed to escape from a bear. That state cannot be sustained for very long and could easily be a trigger for psychosis, even in someone who has never been psychotic.

    Dehydration and hyperthermia might help trigger it too, there were reports that there were empty water bottles in his car. Hypoglycemia might trigger it too. His car had broken down. He might not have eaten breakfast that day.

    It may have just been bad luck, a number of different things happened simultaneously and the combination made him psychotic.

  7. DOYLEon 29 Jun 2012 at 1:22 pm

    A vexing notion always troubles me when i hear the accounts or testimonials of family and witnesses who speak towards a perpetrators history and behavior.Many times the rush to characterize a family member or neighbor as normal hints of denial and protectiveness.In addition many of our”neighbors”,have to my mind,flat and unacute observation.I know this seems pompous but,how many times have you read that the pediphile or father slaughtering his family was quiet and kept to himself.

  8. anneymarieon 29 Jun 2012 at 1:27 pm

    Correction: there is a history of violence. It’s been reported in many articles that Rudy threatened to kill his mother a few years back, resulting in a 911 call.

    “Three years earlier, Eugene had made a similar threat to the very mother that is now defending her son. Eugene was tased by police in 2004, becoming the first man to get tased by Miami police after his mother had called for help from her son. ‘I’ll put a gun to your head and kill you,’ police said, repeating Eugene’s threat to his mother on that day. Eugene also threatened police officers, stating he was going to ‘kick [their] a–.’”

    http://m.christianpost.com/news/rudy-eugene-threats-im-going-to-kill-you-to-boxer-melton-bowen-2007-mother-in-2004-video–76011/

  9. anneymarieon 29 Jun 2012 at 1:34 pm

    From http://miami.cbslocal.com/2012/05/30/who-was-causeway-cannibal-rudy-eugene/
    “Eugene had repeated trouble with the law.

    Florida Department of Law Enforcement records show Eugene was arrested by Miami Beach police on a battery charge when he was 16, but the case was dropped.

    In 2004, North Miami Beach Police had to use a Taser to subdue him during a domestic dispute.

    In that dispute, police said Eugene yelled at his mother, saying ‘You see what I can do?’ and ‘How do you feel now?’ during the attack that saw him break a table and shove her out of the kitchen according to North Miami Beach Police.

    When officers confronted Eugene inside the home he asked ‘What-you-gonna-do?’ Eugene refused to leave and told one officer, ‘I’ll kick your ass,’ according to the police report.

    Charles told police at the time, ‘Thank God your [sic] here, he would have killed me.’ She also told police that Eugene told her, ‘I’ll put a gun to your head and kill you.’”

  10. HHCon 29 Jun 2012 at 2:55 pm

    Behavioral case history: Prior occupations are football player and car wash attendant. So he has been trained to attack in the heat on the field. Given his work history, he’s probably gotten so wet from car washing and heat that he remembers stripping off his clothes. Now add his New Testament with their crazy ideas about sin and Adam, then add marijuana and something toxic to huff, and I think we have the one time acting-out hostility attack on another man. Also, we learned he’s a biter when he fights. This is not the first time that a wild man did not heed a rational plea from a uniformed officer to cease is behavior in the heat of passion. But this time certainly was this Floridian’s last.

  11. etatroon 29 Jun 2012 at 3:28 pm

    Daedalus2u- I have never heard of this “mitochondrial uncoupling” thing as a systemic disease. There are such things as mitochondria uncoupling proteins, which causes the proton gradient in mitochondria to dissipate. Seems like a false silver bullet to me.

    Your fight-or-flight description doesn’t make sense either. If you’re running from a bear, the mitochondria should produce energy in the form of ATP so that muscles can convert it into mechanical energy. What you’re describing would cause the energy to dissipate away as heat — exactly the opposite of what one would want or expect. I think you’re confusing some metabolic changes that happen during fight-or-flight, which are a complicated result of cortisol, noradrenaline, adrenaline; the body temporarily breaks down fats into sugars, stops processing sugars from the gut, transfers energy from maintenance activities to muscle performance. Which is the opposite of what you’re describing in this “mitochondrial uncoupling.”

  12. Kobraon 29 Jun 2012 at 3:44 pm

    What about the possibility of an insidious infectious disease agent, much like toxoplasmosis, playing a role in eliciting or exacerbating psychotic effects?

    And the real question isn’t really whether he’s psychotic; those features are exhibited in nearly everybody at some point throughout one’s lifetime. The real question is more-or-less, what could cause a human being to start chewing the face of another human being? The fact that he chewed on the victim’s face is what made the news. If it were something along the lines of shooting the victim or stabbing the victim, the gravity of this case would be far less than what it is now.

    Regardless, this is a fairly interesting case.

  13. Kobraon 29 Jun 2012 at 3:46 pm

    Bah, can’t edit, wanted to take the middle paragraph out seeing as how I reiterated what Dr. N said in the beginning.

  14. HHCon 29 Jun 2012 at 4:14 pm

    Just for clarity, this case probably included the sin of Apocalyptic thinking in 2012.

  15. tmac57on 29 Jun 2012 at 4:56 pm

    Cannibal…cannabis…coincidence???

  16. daedalus2uon 29 Jun 2012 at 6:16 pm

    eatro, no. What is needed in fight-or-flight is high ATP production rate. So that ATP can be used at a high rate. ATP is not stored, it is produced as it is needed and as it is used and used up.

    When you go into fight-or-flight, your liver dumps glucose into your blood stream at a high rate. It does this because there is a delay between when glucose is put into the blood stream and when it can be utilized. It has to put glucose into the blood stream before it is needed because if it waits, it will be too late.

    There is a delay between when ATP can be made and when it can be utilized. Multiple things need to be done before ATP can be generated at a high rate. The liver has to put a lot of glucose into the blood stream, the heart has to be pumping a lot of blood, the lungs have to be putting a lot of O2 into the blood stream, there has to be a large gradient in O2 partial pressure between the vessel wall and the mitochondria that are being asked to produce ATP at a high rate (so there can be a high flux of O2).

    There can’t be a high gradient of O2 between the vessel wall and mitochondria unless mitochondria are consuming O2 at a high rate. Mitochondria can’t consume O2 at a high rate unless they reduce the O2 to water. Mitochondria need to consume reducing equivalents to do that. Mitochondria can’t make ATP with that energy because there isn’t a sink of ATP to generate the ADP and Pi that mitochondria use to make ATP. Mitochondria need an ATP sink, and that is what mitochondria uncoupling does, dissipate the mitochondria potential as heat, consuming ATP, dropping the ATP level which triggers ATP conservation pathways, which divert ATP to immediate consumption and turn off “luxuries” such a repair. Low ATP also triggers high rate ATP production by mitochondria.

    The ATP level is lower during fight-or-flight, but the ATP flux is higher. Muscles can consume ATP down to levels that kill the cell. This is a “feature”. It is better to have muscles with necrotic spots that are still working and allowing you to run from a bear than to have intact muscles and be caught. This is why the heart will beat itself to death. A beating heart with necrotic spots is infinitely better than an intact heart that has stopped.

    Unless you are actually running, you can’t consume that ATP with your muscles. You need to consume it to get all the auxiliary systems that allow high rate ATP production to occur. It is low ATP concentration that signals mitochondria to produce ATP at a high rate. The easiest thing to do is dissipate it as heat via mitochondria uncoupling. Of course you can’t do that for very long or you will die, but you don’t need to. You just need to escape from the bear, or die trying.

  17. daedalus2uon 29 Jun 2012 at 6:38 pm

    One of the very important signaling pathways that is activated in fight-or-flight is the lowering of nitric oxide. This is absolutely necessary to generate a high flux of ATP by mitochondria, the normal basal level of NO at rest is what inhibits cytochrome c oxidase and prevents O2 binding. Mitochondria have to release that inhibition by lowering the NO level, which they do by generating superoxide. With cytochrome c oxidase blocked, the respiration chain accumulates electrons and becomes reduced, O2 picks up electrons from complex 3 and forms superoxide. The superoxide pulls down the NO level, cytochrome c oxidase becomes disinhibited, binds O2, O2 is reduced to water, the respiration chain becomes oxidized and superoxide production goes down.

    High rate production of ATP requires a high mitochondria potential which increases superoxide production. Disinhibiting cytochrome c oxidase allows O2 to be consumed to a low partial pressure which provides the driving force for the passive diffusion of O2 to mitochondria.

    The low NO also regulates ATP levels to be low via their combined effects on sGC. The reduced ATP concentration turns off non-essential ATP consuming pathways to free up more ATP production capacity for running from the bear.

    That low NO also has neuropsychiatric effects. It is part of what causes roid rage, and many of the rage-inducing effects of stimulants. There was work done with decorticated cats. If you remove certain brain centers, cats are ok, until they are triggered to be in a fight-or-flight state. That state has hysteresis and with those centers gone, they can’t get out of it and so they are in a rage until they die from exhaustion, usually in a few hours. Fight-or-flight is a global response, you need a global control system to turn it on, and a global control signal to turn it off.

  18. Jared Olsenon 30 Jun 2012 at 4:03 am

    I don’t think the dope per se would have caused the meltdown, but the fact that he used pot might indicate he used other, more serious, street drugs…

  19. tMemeon 30 Jun 2012 at 7:51 am

    I don’t think that it is necessary to assume that he suffered from an psychiatric illness or that his psychosis was drug induced until there is good evidence for it.
    I think its perfectly possible that he had something like an brief reactive psychosis: http://en.wikipedia.org/wiki/Brief_reactive_psychosis
    It would be interesting to know, if something stressful or traumatic happend to Eugene before his bizarre and violent attack.

  20. NewRonon 01 Jul 2012 at 3:20 am

    Applying Occam’s razor – the devil made him do it.

    Excepting this case of a live victim, what is the intrinsic difference between cannibalism and transplantation?

  21. Monkeyon 01 Jul 2012 at 12:02 pm

    They found what appeared to be undigested pills in his stomach, so other extreme events involving bath salts led to the initial suspicion. Which begs the question, did they or could they not directly test these “undigested pills”? No one here mentioned that, it’s very much hanging in the air…

  22. Nitpickingon 01 Jul 2012 at 9:55 pm

    Etatro, perhaps a minor point but fat cannot be broken down to sugars. Fat supplies energy as ketone bodies. (Technically triglycerides do provide a small amount of sugar but in terms of energy supplied it’s not significant.)

    That’s why during starvation muscle tends to be destroyed. The brain can’t function on ketone bodies, so the body digests muscle proteins to create glucose, at the expense of the actual muscle.

  23. daedalus2uon 02 Jul 2012 at 9:26 am

    Nitpick, the brain can function on ketone bodies. Pretty much any cells with mitochondria can survive on ketone bodies. Red blood cells don’t have mitochondria and so they require glycolysis.

    There are 3-carbon intermediates in the Krebs cycle that can’t come from lipids and as they need to be replaced, amino acids need to be broken down to supply them.

    A lot of immune cells need to use glycolysis because they need to operate in hypoxic regions of necrotic tissues.

  24. etatroon 02 Jul 2012 at 11:13 am

    I’ve done a lit search in PubMed and haven’t found anything that would relate “mitochondrial uncoupling,” to psychiatric disorders. Uncoupling Protein 2 (UCP2) mRNA was increased in the post-mortem brain of schizophrenia and bipolar patients in one study. I just don’t think that “mitochondrial uncoupling” is a diagnosable medical phenomenon. Especially a psychotic episode. The fully developed human brain relies on glucose for energy. Though it could survive on keytone bodies, it only does this during starvation situations.

    I wonder if they saved Eugene’s brain for pathological study. Should follow up on it. I think that he was in a socioeconomic group where psychiatric disorders may go undiagnosed & untreated for a long, long time. People in his situation usually end up as a “crazy homeless guy.” It is possible that he had something like a psychotic schizophrenic event; and completely lost touch with reality.

    Also, I don’t think we should refer to him as a cannibal anymore. He didn’t swallow the tissue, and it doesn’t seem as though he was planning or choosing to eat human flesh. The crazy college student in Baltimore is another story, though. I would call him a cannibal because he saved specific parts for consumption.

    Also, regarding the clothing thing. We don’t know whether his body temperature was actually elevated or not. During psychotic events, people take their clothes off. Some people have heightened sense of touch or itch or pain and that coupled with a loss of inhibition will cause them to take their clothes off. Probably the disinhibition is enough (I’ve known toddlers who make a habit of getting naked for no apparent reason). If his body temperature were actually elevated, I highly doubt that his brain was actually physically “hot.” I believe that the hypothalamus controls body temperature — if it was somehow not functioning properly and its sensors indicated that his body temperature was colder than it actually was, it would cause his core body temperature to rise; whatever the heightened emotional state and hormones or neuropeptides were signaling to his hypothalamus was out of control and caused his metabolism to go out of whack to the point that his temperature elevated (or he stopped sweating or something). Maybe this is your UCP response, Daed, but I think it’s a step or 3 in the process, not the cause of his breakdown.

  25. Ken-Yoshion 02 Jul 2012 at 6:03 pm

    Maybe… he was just hot and hungry.

    AND… he didn’t actually ‘kill’ anybody… he was biting the dude, but not actually eating the flesh.

    Therefore he was not a killer nor a cannibal… he was just hot and hungry!!!

    Just kidding… enjoyed the explanations Dr. Novella.

  26. elizabethjacobsonon 02 Jul 2012 at 7:27 pm

    I live right by where the attack happened so i have been following this closely.
    Good article but couple issues taken into account

    1. he does a history of violence and was actually the first person in north miami beach to be tased by the police. when he was about 17 or 18 he had a fight with his mother and she called 911 saying he was going to kill her. The police officer actually remembers the case and said his eyes looked empty and he could not understand or hear commands made by officers for him to calm down, and they had to tase him several times to get him under control. This is what made me think he had a psychotic break maybe caused by underlying schizophrenia emerging. his age puts him in the range most men develop the illness and the tendencies were there if you believe the officers story.
    2. he had a bunch of pills in his stomach and i don’t know why but they have not been able to identify them, so who knows why they were and what they activated. It was also 95 degrees that day and he walked over 5 miles in the heat.
    3. he told his best friend he had some important news but he was afraid no one would understand and his family were deeply religious hatian immigrants who apparently bombarded him with threats of the devil and things of that nature, which to a person in the beginning of schizophrenia, would be very stressful.
    thats all, just wanted to share

Trackback URI | Comments RSS

Leave a Reply

You must be logged in to post a comment.