摘要:

Sudden unexpected death in epilepsy refers to sudden death of an individual with a clinical history of epilepsy, in whom a postmortem examination fails to uncover a gross anatomic, toxicologic, or environmental cause of death. Evidence of terminal seizure activity may not be present. One to two percent of natural deaths certified by the medicolegal death investigator are attributed to epilepsy. Detailed microscopic examination of the brain has increasingly afforded the identification of structural changes representative of epileptogenic foci. The authors present 70 cases of death attributed to sudden unexpected death in epilepsy. These cases were classified as follows: individuals who lacked a gross brain lesion, those who had a brain lesion demonstrable at autopsy, and those who lacked neuropathologic evaluation because of decomposition or because only an external examination was done. All of the subjects had a clinical history of seizures. The authors confirm that various microscopic findings, including neuronal clusters, increased perivascular oligodendroglia, gliosis, cystic gliotic lesions, decreased myelin, cerebellar Bergmann’s gliosis, and folial atrophy, are present in a higher percentage of the brains of sudden unexpected death in epilepsy subjects than in the brains of age- and sex-matched control subjects.

ISSN:0195-7910    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Deaths due to cyanide poisoning are relatively rare, largely owing to the restricted availability of cyanide. Nevertheless, the authors report five cases of cyanide fatalities occurring within a few months. Cyanide is one of the most rapidly acting poisons known and is still used for suicide and homicide. The discussion focuses on the circumstances, metabolic changes, pathophysiology, blood levels, diagnosis, and management of cyanide poisoning.

ISSN:0195-7910    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

We report the use of immunohistochemical staining for analysis of forensic evidence from a double homicide. A 38-year-old woman and her 7-year-old daughter were murdered by multiple blows to the head and face with a tomahawk, resulting in multiple fragments of brain tissue scattered about the murder scene. The victims’ husband and father was the main suspect, who maintained that he was out of town on business during the evening of the murders. However, a shirt taken from the suspect’s car on the morning after the murders (secured by the police before the suspect visited the murder scene) was found to have two small stains. DNA analysis on the stains showed the presence of the deceased wife’s DNA, and immunohistochemical stains on shirt fragments conclusively documented the presence of deep central nervous system tissue, providing the critical piece of evidence needed to arrest and prosecute the suspect. This report demonstrates that shirt or similar cloth fragments can be processed into paraffin blocks and subsequently immunostained to search for and classify types of tissue fragments that may be present on the fabric.

ISSN:0195-7910    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

The authors describe a case of suicide by a single shot to the head from the latest type of captive bolt pistol (which has lateral instead of frontal gas outlets), with the aim of finding criteria to identify correctly the lesions caused by this type of weapon correctly and to distinguish them from those caused by typical firearms.

ISSN:0195-7910    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Suicide by simultaneous gunshots with two firearms is rare. The case of a 90-year-old man who killed himself with two 6.35 mm pistols fired at the temples at the same time is presented. The victim was found dead on the terrace of his home; two guns and two cartridges were present near the corpse. Cases of suicides with two guns published in the literature are compared, and the Italian cases are illustrated briefly. The authors describe the circumstances and autopsy findings that permitted the assertion that it was a case of suicide and to exclude an homicide and show, by figures, the three-dimensional reconstruction of cranial shooting injuries. The use of two guns is considered a representation of a special type of “combined suicide” or “planned complex suicide.”

ISSN:0195-7910    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Self-inflicted eye injuries among psychiatric patients are relatively common. Transorbital penetrating traumas are more rare but if undiagnosed may cause lethal intracranial lesions. We report a fatal case of a 25-year-old schizophrenic man who introduced a plastic ballpoint pen through his right orbit up to the cerebellum. The computed tomography findings were misinterpreted as a penetrating track from a bullet. The patient died 4 days after the trauma, and the causative object was identified only at autopsy. When no precise information about an apparently trivial ocular trauma is available, clinicians and investigators must adequately consider, especially in psychiatric patients, the possibility of an intracranial penetrating lesion.

ISSN:0195-7910    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Rupture of a splenic artery aneurysm is a rare and usually catastrophic event, most commonly associated with pregnancy. In spite of increasingly common reliance on abdominal angiography, magnetic resonance imaging, and computerized tomography during the past quarter century, clinicians uncommonly recognize any of the various splanchnic arterial aneurysms absent premonitory signs or symptoms. Accordingly, rupture of a visceral aneurysm, including splenic artery aneurysm, typically presents as sudden, unexpected obtundation or death. As a consequence, the initial recognition and diagnosis of splenic artery aneurysm rupture take place only at autopsy. This report presents two such cases of sudden death resulting from splenic artery aneurysm in a pregnant woman and a postpartum woman, respectively.

ISSN:0195-7910    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Two cases of massive iliopsoas muscle bleeding leading to fatal exsanguination are presented. Both patients (two women, 61 and 74 years old, respectively) received oral anticoagulation with phenprocoumon. The intramuscular bleeding occurred spontaneously in women of relatively good physical condition. Intriguingly, phenprocoumon concentrations were within the therapeutic range (1.55 &mgr;g/ml and 1.26 &mgr;g/ml, respectively) as detected by toxicologic analysis. These cases demonstrate that severe bleeding in the iliopsoas muscle has to be considered in all patients receiving anticoagulant medication, even in those who have coagulation parameters within the therapeutic range. Especially in older patients with a high degree of comorbidity or in patients receiving analgesic drugs, the potential of fatal outcome of iliopsoas muscle bleeding seems to be of clinicopathologic relevance.

ISSN:0195-7910    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Relatives of deceased persons, on whose body a forensic autopsy had been performed at the Institute of Forensic Science, Bern, Switzerland, were interrogated by a questionnaire. The aim was to investigate the attitude of relatives toward medicolegal investigation procedures in general and toward forensic autopsy in particular. A great majority of the relatives showed a positive or indifferent attitude toward a forensic autopsy. They showed a great interest in autopsy results and wished to be informed. It was concluded that information given before the autopsy is important for better understanding and can, if properly given, improve the relatives’ acceptance and collaboration regarding forensic investigations. By contrast, a lack of information before the autopsy and about the autopsy results can cause further suffering on behalf of the bereaved. A forensic autopsy can be of great benefit for relatives and can help them to cope with a tragic loss.

ISSN:0195-7910    

出版商:OVID    

年代:2002

数据来源: OVID

摘要:

Twenty-three paired skin samples from 19 autopsies without putrefaction were taken from areas of livor mortis that (1) did not blanch with finger pressure and (2) blanched with strong pressure by tweezers. Three-dimensional microscopic viewing of 100-&mgr;m benzidine-stained skin sections demonstrated small blood vessels filled with red blood cells. The diameters of the clumps of red blood cells were greater in the sections from non-blanched areas than in the blanched areas, suggesting that fixation of hypostasis soon after death depends on sedimentation of intravascular red blood cells and passive dilatation of small vessels rather than on postmortem hemolysis.

ISSN:0195-7910    

出版商:OVID    

年代:2002

数据来源: OVID