Wischnewski spots in a case of accidental hypothermia.

Accidental hypothermia can be fatal, and is often associated with confusion and paradoxical undressing. Wischnewski spots are a classic manifestation of hypothermia at autopsy.

Hypothermia Deaths in Van Province, Turkey

ABSTRACT Objective: To evaluate autopsy findings in hypothermia-related deaths in Van Province, Turkey, a city near the Turkey-Iran border. Methods: Autopsy reports on 43 hypothermia fatalities were retrospectively reviewed. Data regarding age, gender, nationality of the cases, seasonality of the deaths, crime scene findings, autopsy findings, manner of deaths, risk factors for hypothermia, other traumatic lesions, and toxicology were obtained from autopsy records and scene investigation records. Results: There were 36 males and 7 females. The mean age was 20.5 years. More than half of the cases died or were found dead in the spring months. All but one of the cases was found dead outdoors. There were common red-coloured livor mortis in 33 cases (76.7%), antemortem traumas in 16 cases (37.2%), cold erythema in 26 cases (60.5%), myxedema in 1 case, bloody discolouration in the synovial fluid in 11 (84.6%) cases, and Wischnewski spots in 32 cases (74.4%). Conclusion: The study showed that illegal refugees are an important social problem in Turkey. Hypothermia should be considered as a cause of death for refugees when they are found, especially in the cold provinces. In the diagnosis of hypothermia, bloody discolouration of the synovial fluid is confirmed to be a valuable finding. Wischnewski spots remain valuable for positive identification.

Are Wischnewski Spots Found Only in Hypothermia? / 대한법의학회지

Wischnewski spots (WS) are multiple black spots observed in the gastric mucosa at autopsy that are considered a reliable and important feature of hypothermia. Nonetheless, the frequency of WS varies widely. WS were discovered in 20 cases out of 3,493 autopsies (0.57%) conducted between 2001 and 2017 in the Department of Forensic Medicine of the School of Medicine, Kyungpook National University in Korea. This study aimed to investigate the distribution and size of WS in these cases and analyze the respective causes of death. Nine cases that occurred in winter were the same as the nine cases with hypothermia as the cause of death or contributory cause. The post-mortem blood alcohol test was positive in eight cases, with acute or chronic alcoholism determined as the cause of death in two of these cases. There were two cases of acute poisoning by pesticides. Putrefaction was noted in six cases (30%). WS presented in various sizes ranging from pinpoint to more than 5 mm in diameter, and the number of WS varied from 5 to 100. WS distribution was diffuse in four cases (20%) and localized in 13 cases (65%). Microscopic examination showed brown to black pigmentation but no neutrophil infiltration or vital reactions in the WS. Thus, WS are associated with hypothermia and are considered post-mortem alterations with variable appearance, size, and distribution. Hypothermia is an exclusive diagnosis at autopsy that should result from a combined assessment of toxicological tests, circumstance of death, and autopsy findings.

Wischnewski spots in fatal burns.

The occurrence of Wischnewski spots in fatal hypothermia has been considered an important indicator of reduced core temperatures, its incidence varying between 40 and 100%. Though many human and animal studies have been conducted to study this phenomenon, the underlying mechanisms contributing to the formation of Wischnewski spots are still not clearly understood. They have been largely reported in human deaths occurring from exposure to freezing temperatures. This is the first reported case of Wischnewski spots observed in a case of fatal burns.

Issues in the diagnosis of hypothermia: a comparison of two geographically separate populations.

A review of hypothermic deaths was undertaken using cases from the Charité University, Berlin, Germany and Forensic Science South Australia, Australia. There were 16 cases from Berlin (age range 38-96 years; average 68 years; M:F = 13:3) Wischnewski spots were present in all 16 cases (100%), skin discolouration in nine (56%), and acute pancreatitis and muscle haemorrhage in one case each (6%). There were 62 Australian cases (age range 30-89 years; average 67 years; M:F = 13:18). Wischnewski spots were present in 57 (92%), skin discolouration in seven (11%), vacuolization of renal cells in six (10%), and acute pancreatitis in one (2%). Reporting of the pathological findings in hypothermia may vary among jurisdictions influenced by the location and nature of these deaths and also by reliance on particular features to make the diagnosis. In addition, it is possible that the aetiology of these markers is quite complex and involves not only a significant reduction in core temperature, but the variable and poorly-understood interaction of a number of other factors.

Why are Wischnewski spots not always present in lethal hypothermia? The results of testing a stress-reduced animal model.

Hypothermic fatalities in humans are characterized by a range of often subtle pathological findings that typically include superficial erosive gastritis (Wischnewski spots). Experimental studies have been successfully performed using animal models to replicate this finding, however study animals have inevitably been subjected to a variety of additional stressors including food deprivation, restraint and partial immersion in water while conscious. As it is recognised that stress on its own may cause superficial erosive gastritis, a model has been developed to enable the study of the effects of hypothermia in isolation. 42 Sprague-Dawley rats were allowed free social contact and were fed and watered ad libitum prior to being anaesthetized with isoflurane. Once unconscious, rats were placed on drape cloth covering metal mesh platforms in a styrofoam box packed with ice. The apparatus enabled both maintenance of a specific low temperature (26 °C) in 14 animals, and continued reduction of core temperatures in the remaining 28 (who all died of hypothermia under anaesthesia). Examination of the gastric mucosa in both groups macroscopically and microscopically failed to demonstrate typical Wischnewski spots in any of the 42 animals. Thus, in this model, death from hypothermia occurred without the development of these lesions. These results suggest that stress may be a significant effect modifier in the development of Wischnewski spots in lethal hypothermia.