Forensic Neuropathology (eBook)

Front cover 1
Forensic Neuropathology 4
Copyright page 5
Table of contents 8
Preface 10
Foreword 12
Acknowledgments 14
Chapter 1: The Forensic Neuropathology Autopsy, I: Selected Gross and Microscopic Examination Considerations 16
Introduction 16
Decomposed Cases 16
The Routine Forensic Neuropathology Autopsy 16
Legal Issues, Including Potential Errors in the Performance of the Forensic Neuropathology Consultation 22
Topographic Approach to Neuropathology 23
Sudden Unexpected Death in Infants and Children Due to Natural Causes, and the Suspected Sudden Infant Death Syndrome Case 23
Time Since Death 24
Craniocerebral Relationships 25
Meninges 25
Brainstem 27
Spinal Cord 28
Neck Dissection 30
Discoloration of Skull, Meninges, and Brain 30
Selected Artifacts 32
Effect of Formalin Fixation on CNS Tissue 37
Pineal Gland 37
References 38
Chapter 2: The Forensic Neuropathology Autopsy, II: Developmental Considerations 42
Introduction 42
Large and Small Heads Large and Small Brains
Hydrocephalus 43
Fontanel Size 44
Central Nervous System Development: Selected Aspects 44
References 60
Chapter 3: Dating/Aging of Common Lesions in Neuropathology 64
Introduction 64
Scalp Injuries 67
Skull Fracture 69
Mineralization in Central Nervous System Lesions 73
Heterotopic Ossification Following Central Nervous System Injury 75
Epidural Hematoma 77
Subdural Hematoma 78
Subarachnoid Hemorrhage 82
Observations on Postmortem Cerebrospinal Fluid Examination 85
Brain Contusions 87
Axonal Spheroids, Diffuse Axonal Injury, and b-APP 89
Traumatic Axonal Injury 92
Puncture Wounds in the Brain 94
Intracerebral Hemorrhage 96
Spinal Cord Traumatic Lesions 97
Schwannosis 99
Spinal Shock 99
Spinal Concussion 102
Adult Cerebral Infarction 103
Generalized Brain Hypoxic-Ischemic Injury 106
Spinal Cord Infarction 107
Brain Death and Respirator Brain 107
Cerebrospinal Fluid Cytology in Stroke 113
Malignant Cerebral Edema 114
Wallerian Degeneration 115
Peripheral Nerve Regeneration 118
Transneuronal Degeneration 119
Astrocyte Terminology 122
Blood Cells in Central Nervous System Lesions 123
Do Reactive Cell Changes of Immature Versus Mature Brain Differ? 124
Denervation of Muscle 127
Muscle Reinnervation 129
References 129
Chapter 4: Neuropathology of Pregnancy and Delivery: Mother and Child 138
Introduction 138
The Pregnant Woman 139
Stillborn Infants 144
Labor and Delivery 145
The Newborn Infant 150
References 161
Chapter 5: Malformations and Other Congenital Central Nervous System Lesions 166
References 180
Chapter 6: Blunt Force Head Injury 182
Introduction 182
Scalp Abrasion, Contusion, and Laceration 182
Subcutaneous Scalp and Subgaleal Hemorrhages 183
Skull Fractures 183
Epidural Hematoma 184
Subdural Hematomas 185
Subarachnoid Hemorrhage 189
Brain Contusions, Lacerations, and Hematomas 192
Diffuse Axonal Injury 198
Brainstem Avulsion 205
Ventricular Hemorrhage 206
Traumatic Cranial Neuropathies 206
Locked-in Syndrome 207
Boxing and Other Sports 207
Consequences of Head Injury 210
References 212
Chapter 7: The Suspected Child Abuse Case 214
Introduction 214
Preliminary Comments 214
Information Sources 218
Tadd Syndrome 219
Tin Ear Syndrome 219
How Unique Is the Mechanism of Head Injury in Your Case? 219
Terson’s Syndrome 219
Shaken Adult Syndrome 220
Crush Injuries to the Head 220
Subdural Hemorrhage in Childhood 220
Folk Remedies and Customs 220
Spinal Injury in Child Abuse 221
Retinal Hemorrhage 221
References 223
Chapter 8: Injuries Due to Firearms and Other Missile-Launching Devices 226
Introduction 226
Information Resources 226
Wound Ballistic Issues 227
Head Wounds 228
Skull Wounds 228
Tangential Skull Wounds 230
Entrance and Exit Wounds of the Skull 230
Internal Ricochet 231
Brain Wound Characteristics 231
Backspatter 235
“Disappearing” Bullets 235
Intermediate Targets 237
Bullet Migration in Bodies 238
Suicidal versus Homicidal Gunshot Wounds to the Head 241
Tandem Bullets 242
Prognostic Factors in Craniocerebral Gunshot Wounds 242
Centerfire Rifle Wounds 243
Shotgun Wounds 243
Potential Complications of Craniospinal Gunshot Wounds 244
Complications of Retained Bullets and Other Missiles Related to Bullet Composition 245
Injury to Death Interval 246
Speed of Incapacitation Issues in Gunshot Wounds 247
Reaction/Response Time Issues 252
Unusual Missile-Launching Devices and Ammunition 254
Firearm Wound Imitators 258
Bullet/Shrapnel Trace Evidence 258
Radiology of Gunshot Wounds 259
Gunshot Wound Autopsy Protocols 261
References 263
Chapter 9: Sudden Unexpected Death 270
Introduction 270
Acute Subarachnoid Hemorrhage 271
Epilepsy 277
Cysticercosis 280
Acute Intracerebral Hemorrhage 283
Vascular Malformation 286
Meningitis 289
Hydrocephalus 290
Tumors 292
Multiple Sclerosis 296
Reye’s Syndrome 296
Reflexes and Sudden Unexpected Death 296
References 299
Chapter 10: Responses of the Central Nervous System to Acute Hypoxic-Ischemic Injury and Related Conditions 304
Introduction 304
Clinical Features 304
Selective Vulnerability of the Central Nervous System to Hypoxic-Ischemic Injury: Cellular Aspects 306
Unusual Patterns of Central Nervous System Injury in Which a Component of Hypoxic-Ischemic Injury Appears to Be a Major Contributory Factor 308
Heat Stroke 310
Epilepsy 312
Asphyxia 312
Hypoglycemia 312
Red Neurons, Dark Neurons, and the Category of “I’m Not Sure How to Interpret These Neurons” 313
References 319
Chapter 11: Vascular Diseases of the Central Nervous System 322
Introduction 322
Cerebral Thrombosis 322
Cerebral Embolism 326
Cerebral Hemorrhage 326
Secondary Changes of Cerebral Infarction 331
Dural Sinus Thrombosis 332
Cerebral Vascular Malformations 332
Ruptured Cerebral Aneurysms 338
Cerebral Amyloid Angiopathy 342
Drug Abuse-Related Cardiovascular Disease 346
States of Altered Consciousness and Their Anatomic Substrates 346
References 348
Chapter 12: Infections of the Central Nervous System 350
Introduction 350
Perinatal Infections 350
Bacterial Infections: Spread from Pericranial Primary Foci 351
Epidural Abscess 351
Subdural Empyema 351
Meningitis 352
Brain Abscess 354
Rickettsial Infections 354
Chronic Bacterial Infections 356
Fungal Infections 357
Viral Infections 360
Transmissible Spongiform Encephalopathies (Prion Diseases) 366
Parasitic Infections 368
Biologic Terrorism 370
References 370
Chapter 13: Brain Tumors 374
Introduction 374
Astrocytic Tumors 374
Oligodendroglioma 385
Ependymoma 385
Medulloblastoma 389
Ganglioglioma 390
Mixed Gliomas 392
Meningioma 392
Schwannomas 397
Tumors of Maldevelopment 398
Chordoma 401
Arachnoid Cyst 402
Lipoma 403
Pituitary Tumors 403
Metastatic Neoplasms 405
Primary Malignant Lymphomas 406
Extramural Metastasis 408
Causes of Brain Tumor 408
References 408
Chapter 14: Neurodegenerative Disorders 410
Introduction 410
Alzheimer’s Disease 410
Pick’s Disease 415
Diffuse Lewy Body Disease 417
Parkinson’s Disease 417
Huntington’s Disease 419
Progressive Supranuclear Palsy 420
Multiple System Atrophy 420
Friedreich’s Ataxia 423
Motor Neuron Disease 424
References 425
Chapter 15: Demyelinating Disorders 428
Multiple Sclerosis 428
Leukodystrophy 433
References 436
Chapter 16: Periprocedural Complications 438
Introduction 438
Definitions 438
Categorization of the Problem 439
Mechanisms of Injury 439
Foreign Materials 448
Surgical Instruments, Hardware, and Ablative Procedures 448
Mechanical Forces 451
Challenges for the Forensic Pathologist 453
Determination of Mode 453
Final Comment 454
References 454
Chapter 17: Miscellaneous Topics 458
Introduction 458
Forensic Neuroradiology 458
Neuropathologic Consequences of Contemporary Judicial Executions 459
Sharp Force Injury 460
Forensic Anthropology 463
Toxicology 466
Neuropathologic Complications of Systemic Diseases 467
References 475
Appendix A: Case Sources for Neuropathology Consultation 480
Appendix B: The Glasgow Coma Scale 481
References 481
Appendix C: The Apgar Score 482
References 482
Appendix D: Intracranial Pressure Monitoring 483
References 483
Appendix E: Legal Testimony 484
Suggested Additional Readings 484
Index 486