Forensic Neuropathology

A Practical Review of the Fundamentals

Hideo H. Itabashi MD, John M. Andrews MD, Uwamie Tomiyasu MD, Stephanie S. Erlich MD, Lakshmanan Sathyavagiswaran, Hideo H. Itabashi, MD, John M. Andrews, MD, Uwamie Tomiyasu, MD, Stephanie S. Erlich, MD

• Publisher: Academic Press
• Year: 2011
• Print ISBN:
  9780120585274
• eBook ISBN:
  9780080549842
• Topic: Droit
• Subtopic: Science médico-légale

Forensic Neuropathology provides superior visual examples of the more commonly encountered conditions in forensic neuropathology and answers questions that arise regarding neuropathological findings. The work includes values for frequently-encountered clinical assessments, and contains a more comprehensive summary of aging/dating of various neuropathological processes than is available in any other single current source. General pathology residents, forensic pathology and neuropathology fellows, and general pathologists and clinicians involved in referred cases will find this book extremely useful, as will individuals in allied fields such as law enforcement officers and attorneys. Forensic Neuropathology aims to: (1) provide a concise summary of practical information frequently needed in forensic neuropathology cases; (2) include selected material previously known but perhaps not significantly emphasized in current literature; and (3) where possible, to suggest aging/dating parameters for certain neuropathological findings relevant to forensic neuropathology testimony. As a selective reference, the volume emphasizes practical issues and focuses on the most commonly encountered issues among neuropathology and medical examiner professionals. - Over 800 high-quality full-color photographs, gross and microscopic as well as illustrative line drawings - Use of actual cases, briefly summarized and illustrated to emphasize key principles - Focuses on the most-commonly encountered cases as relate to forensic incident and covers these aspects in depth and detail

1

The Forensic Neuropathology Autopsy

I: Selected Gross and Microscopic Examination Considerations

Publisher Summary

On certain occasions, it becomes necessary to explore a particular topic relevant to the forensic neuropathology consultation in great detail. This chapter highlights selected sources and issues that are helpful in routine categories. This chapter includes a review of forensic pathology issues, including autopsy procedures, designed primarily for attorneys; forensic pathology textbooks and articles that include sections on differences between routine hospital and forensic autopsy procedures, and/or techniques more commonly used in forensic autopsies, and articles and monographs more specifically directed to neuropathology aspects of the autopsy. The chapter further illustrates certain legal issues, including potential errors in performance of forensic neuropathology consultation. It is recommended that consulting forensic neuropathologists should avoid the most common potential errors in the performance of forensic autopsies. These issues are emphasized in forensic pathology, but not generally in neuropathology, training programs.

INTRODUCTION

DECOMPOSED CASES

THE ROUTINE FORENSIC NEUROPATHOLOGY AUTOPSY

LEGAL ISSUES, INCLUDING POTENTIAL ERRORS IN THE PERFORMANCE OF THE FORENSIC NEUROPATHOLOGY CONSULTATION

TOPOGRAPHIC APPROACH TO NEUROPATHOLOGY

SUDDEN UNEXPECTED DEATH IN INFANTS AND CHILDREN DUE TO NATURAL CAUSES, AND THE SUSPECTED SUDDEN INFANT DEATH SYNDROME CASE

TIME SINCE DEATH

CRANIOCEREBRAL RELATIONSHIPS

MENINGES

BRAINSTEM

SPINAL CORD

NECK DISSECTION

DISCOLORATION OF SKULL, MENINGES, AND BRAIN

SELECTED ARTIFACTS

EFFECT OF FORMALIN FIXATION ON CNS TISSUE

PINEAL GLAND

REFERENCES

Introduction

The references cited at the end of this chapter include a review of forensic pathology issues, including autopsy procedures, designed primarily for attorneys⁵⁶; forensic pathology textbooks and articles that include sections on differences between routine hospital and forensic autopsy procedures and/or techniques more commonly used in forensic autopsies^{36,39,45,101,112,129,140,144,148}; and articles and monographs more specifically directed to neuropathology aspects of the autopsy.^38,123,166

On occasion, however, it becomes necessary to explore a particular topic relevant to the forensic neuropathology consultation in greater detail. The goal of this chapter is to highlight selected sources and issues we found helpful in the categories that follow.

Decomposed Cases

There is an understandable tendency to dispense with examination of decomposed tissues as unnecessary or unproductive activity in any busy office. It has been our experience, however, that in cases with “Swiss-cheese” type change, with centrally located pink-colored softening due to poor penetration of formalin, or with decomposition that has progressed to the point that central nervous system (CNS) tissue consistency was just barely firm enough to be cut into a block for embedding, a surprising degree of histologic detail sometimes remained. Others have had a similar experience,¹¹⁸ and making the attempt is worthwhile if an important neuropathologic question might be clarified. Even brain tissue decomposed to the consistency of soft paste can be submitted for toxicologic screening, and often yields useful qualitative, if not quantitative, results. Common artifacts in forensic material are seen in Figs. 1.1–1.5.

Fig. 1.1 Coronal section of brain with multiple cystic spaces due to postmortem overgrowth of gas forming bacteria; so-called “Swiss-cheese” artifact.

Fig. 1.2 Detail of cysts due to gas forming organisms. Smooth walls, no tissue reaction, punched-out appearance.

Fig. 1.3 Low-power micrograph of “Swiss-cheese” artifact. No evidence of tissue reaction. At higher power, bacteria will be evident (usually rod-shaped or mixed flora) in cyst wall and nearby parenchyma. (H&E.)

Fig. 1.4 Roughened cerebral cortical surface due to superficial cortical avulsion. This artifact occurs when fresh or fixed cortex moves against, or is excessively indented by, rough or textured surfaces such as surgical caps (when brain is suspended in fixative) or paper towels, and is to be distinguished from granular cortical atrophy.

Fig. 1.5 Portions of longitudinal section of fly larva (maggot), encountered in cases with more advanced decomposition (and on some forensic board examinations). (H&E.)

The Routine Forensic Neuropathology Autopsy

Our role as forensic neuropathology consultants places us in the position of having our portion of the case evaluation compromised if specimens provided us contain significant preventable artifact, since we are not present at the time of autopsy in most cases. Direct communication with the medical examiner facilitates the extra care necessary for successful brain and/or spinal cord removal with the least amount of damage.

Most readers will already have arrived at a protocol for the CNS portion of the general autopsy with which they are comfortable and proficient, and descriptions of various techniques of brain and spinal cord removal in routine adult autopsies are easily found. Finkbeiner et al.⁴⁵ and Ludwig¹⁰¹ provide suggested CNS techniques in greater detail than many other texts on a...

Table of contents

• Cover image
• Title page
• Table of Contents
• Preface
• Foreword
• Acknowledgments
• Chapter 1: The Forensic Neuropathology Autopsy: I: Selected Gross and Microscopic Examination Considerations
• Chapter 2: The Forensic Neuropathology Autopsy: II: Developmental Considerations
• Chapter 3: Dating/Aging of Common Lesions in Neuropathology
• Chapter 4: Neuropathology of pregnancy and delivery: Mother and child
• Chapter 5: Malformations and Other Congenital Central Nervous System Lesions
• Chapter 6: Blunt Force Head Injury
• Chapter 7: The Suspected Child Abuse Case
• Chapter 8: Injuries Due to Firearms and Other Missile-Launching Devices
• Chapter 9: Sudden Unexpected Death
• Chapter 10: Responses of the Central Nervous System to Acute Hypoxic-Ischemic Injury and Related Conditions
• Chapter 11: Vascular Diseases of the Central Nervous System
• Chapter 12: Infections of the Central Nervous System
• Chapter 13: Brain Tumors
• Chapter 14: Neurodegenerative Disorder
• Chapter 15: Demyelinating Disorders
• Chapter 16: Periprocedural Complications
• Chapter 17: Miscellaneous Topics
• Appendix A: Case Sources for Neuropathology Consultation
• Appendix B: The Glasgow Coma Scale
• Appendix C: The Apgar Score
• Appendix D: Intracranial Pressure Monitoring
• Appendix E: Legal Testimony
• Index