Differences in Sampling Site on Postmortem Cerebrospinal Fluid Biochemistry: A Preliminary Study.

Cerebrospinal fluid (CSF) is often analyzed at postmortem. The presented preliminary study compared postmortem CSF samples for biochemical analysis from the subarachnoid space around the spinal cord and ventricular space of the brain. This study compared 15 paired CSF samples in which the CSF from the subarachnoid space via lumbar puncture had higher sodium and chloride levels and lower magnesium and potassium levels than CSF from the ventricles. The differences correlated significantly with the deceased's age and had a similar trend with postmortem interval. This study suggests that CSF from different collection sites has different electrolyte concentrations, which are age and possibly postmortem interval dependent. When collecting CSF, the pathologist should document the collection site, age, and postmortem interval, and the mixing of CSF samples from different sites should be avoided. Further studies are warranted to clarify other possible reasons to explain the observed differences.

Metal Railing Fences and Accidental Death.

Two cases of accidental deaths caused by the sharp ends of fence or gate posts are reported. Case 1: A 47-year-old man was found hanging by his ankle in an inverted position on fencing. He had attempted a shortcut to a railway platform by climbing over a metal rail fence. He had slipped and been impaled through his ankle by the sharp end of the fence post, resulting in death from positional asphyxia. Case 2: An 18-year-old male slipped while climbing over a gate and died after being impaled on a spear tip finial, which had lacerated his external iliac vein. Death was due to exsanguination. These cases demonstrate two rare examples of accidental deaths from impalement by the ends of sharp fence posts. Mechanisms of death in such circumstances involve suspension with positional asphyxia and vascular injury with exsanguination.

Hinged Lids and Fatal Head Entrapment in Early Childhood.

Young children are at risk of head entrapment because they often do not understand potentially dangerous situations or have the intellectual or physical capabilities to self-extricate. Two cases of head entrapment due to hinged lids are presented to demonstrate another rare lethal situation specific to the very young. Case 1 was a 14-month-old boy found suspended by his neck in a semikneeling position under a toilet seat. A horizontal linear bruise measuring 0.6 × 20 mm was present on the right side of the neck with petechial hemorrhages of the forehead. Death was due to neck compression from head entrapment with aspiration of gastric contents. Case 2 was a 17-month-old girl found suspended by her neck from the side of her crib by a hinged cover. A horizontal linear bruise measuring 10 × 50 mm was present immediately below the suprasternal notch with numerous petechial hemorrhages of the conjunctivae and face. Death was due to neck compression from head entrapment. Although these cases are very rare, they do show the potential danger that hinged lids may present to toddlers. Autopsy evaluations require comparisons of injuries with the structure and edges of the entrapping device/object.

Neisseria meningitidis Isolated in Postmortem Vitreous Humor in a Death Due to Meningococcal Sepsis.

Sepsis remains a difficult diagnosis at autopsy. With respect to meningococcal sepsis, a timely and definite diagnosis is critical because it requires public health department notification and the administration of prophylactic antibiotics to potential close contacts. A previous case series, in which both blood and cerebrospinal fluid were unavailable, suggested vitreous humor polymerase chain reaction might be a useful test in diagnosing meningococcal sepsis. We describe a fatal case of meningococcal sepsis where Neisseria meningitidis was detected in both vitreous humor and blood polymerase chain reaction, in addition to positive blood cultures. This gives further support to using microbiology of vitreous humor in suspected meningococcal sepsis, especially when microbiology samples are limited.

Immersion of Bovine Eyeballs After 1 Hour in Seawater Does Not Result in Elevation of Postmortem Vitreous Humor Sodium and Chloride Levels.

BACKGROUND: Elevations in postmortem vitreous sodium chloride (PMVSC) levels may help in differentiating saltwater/seawater drowning (SWD) deaths from immersion deaths not related to drowning (DNRD). It is unclear whether the elevation is related to blood/plasma electrolyte changes after inhalation of seawater as hypothesized in SWDs or possibly caused by electrolyte diffusion and/or osmosis across the outer coats of the eyeball during immersion. AIM: To investigate the changes in bovine PMVSC levels at different time points while immersed in seawater. METHODS: Bovine eyeballs were obtained from an abattoir and randomized into 2 groups: a) submerged in seawater ("wet" group) or b) placed in an impermeable plastic bag that was immersed in seawater ("dry" group). The PMVSC levels from 6 eyeballs were measured from each group (without replacement) at 30 minutes, 1 hour, 6 hours, and 12 hours. RESULTS: There was no significant difference in mean PMVSC levels between the 2 groups at 30-minute and 1-hour intervals. A significant difference was noted from 6 hours onward. DISCUSSION: There is no statistically significant elevation in bovine PMVSC levels when immersed in seawater for up to 1 hour. Assuming similar physical properties in humans, any elevations in PMVSC levels in bodies immersed in seawater for less than 1 hour should not be caused by immersion.

Hyperdensity of the Basilar Artery on Postmortem CT: A Potential Indicator for Basilar Artery Thrombosis.

Basilar artery thrombosis constitutes 1% of all types of stroke, carries a mortality rate of up to 90%, and is one of the rarer causes of sudden death. It leads to brain stem ischemia and commonly presents with impaired consciousness, cranial nerve palsy, hemiplegia or quadriplegia, and sudden collapse. Clinically, the diagnosis of basilar artery thrombosis is made on clinical symptoms, along with a hyperdense basilar artery in antemortem computed tomography (CT) scan. To our knowledge, whether a hyperdense basilar artery indicates basilar artery thrombosis on postmortem CT scan is not documented in the literature. We present a case report of a 55-year-old man who on postmortem CT scan showed a hyperdense basilar artery and was subsequently confirmed to be a fatal basilar artery thrombosis. We suggest that a hyperdense basilar artery on postmortem CT should prompt the pathologist to consider basilar artery thrombosis.