Category Archives: Forensic pathology

Journal articles relating to forensic pathology including coronial autopsies and Disaster victim identification.

Impact height and wall distance in bloodstain pattern analysis—what patterns of round bloodstains can tell us

International Journal of Legal Medicine September 2014
Bloodstain pattern analysis is a routine procedure in forensic cases that involve bleeding wounds. It utilizes geometric principles to determine the sequence of actions causing the bloodshed and the area of origin, that is, from where the blood originated. The patterns formed by circular bloodstains from drops of blood that hit adjacent surfaces at a 90-degree angle are thought to provide indications of the height of the impact. In this study, blunt force exerted against a pool of blood, which was used as a surrogate for a bleeding wound, was carried out for five different impact-to-wall distances. The blunt force consisted of a hammer head that was dropped from a height of 1.5 m. High-speed photography of the impact and trajectories of the projected blood droplets was analysed. The patterns containing bloodstains produced by the droplets were analysed by measuring the circular bloodstains within the patterns. All the experiments showed that there were two distinct patterns or clusters of circular bloodstains that occurred at different heights above the impact site. The two patterns were a result of different fractions of blood that were projected in a garland or crown-like form of a “Worthington splash” after impact. The findings suggest that patterns of circular bloodstains cannot be used as direct indicators of impact height, but combined analysis of their clusters may lead to indirect determination of impact-to-wall distance and area of origin.

Perimortem trauma in King Richard III: a skeletal analysis

Lancet, Online 16 September 2014, DOI: 10.1016/S0140-6736(14)60804

Background

Richard III was the last king of England to die in battle, but how he died is unknown. On Sept 4, 2012, a skeleton was excavated in Leicester that was identified as Richard. We investigated the trauma to the skeleton with modern forensic techniques, such as conventional CT and micro-CT scanning, to characterise the injuries and establish the probable cause of death.

Methods

We assessed age and sex through direct analysis of the skeleton and from CT images. All bones were examined under direct light and multi-spectral illumination. We then scanned the skeleton with whole-body post-mortem CT. We subsequently examined bones with identified injuries with micro-CT. We deemed that trauma was perimortem when we recorded no evidence of healing and when breakage characteristics were typical of fresh bone. We used previous data to identify the weapons responsible for the recorded injuries.

Findings

The skeleton was that of an adult man with a gracile build and severe scoliosis of the thoracic spine. Standard anthropological age estimation techniques based on dry bone analysis gave an age range between 20s and 30s. Standard post-mortem CT methods were used to assess rib end morphology, auricular surfaces, pubic symphyseal face, and cranial sutures, to produce a multifactorial narrower age range estimation of 30–34 years. We identified nine perimortem injuries to the skull and two to the postcranial skeleton. We identified no healed injuries. The injuries were consistent with those created by weapons from the later medieval period. We could not identify the specific order of the injuries, because they were all distinct, with no overlapping wounds. Three of the injuries—two to the inferior cranium and one to the pelvis—could have been fatal.

Interpretation

The wounds to the skull suggest that Richard was not wearing a helmet, although the absence of defensive wounds on his arms and hands suggests he was still otherwise armoured. Therefore, the potentially fatal pelvis injury was probably received post mortem, meaning that the most likely injuries to have caused his death are the two to the inferior cranium.

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Encephalopathy and death in infants with abusive head trauma is due to hypoxic-ischemic injury following local brain trauma to vital brainstem centers

International Journal of Legal Medicine    August 2014;  DOI: 10.1007/s00414-014-1060-7

Background

Infants with abusive head trauma (AHT) have diffuse brain damage with potentially fatal brain swelling. The pathogenesis of the brain damage remains unclear. We hypothesize that brain damage in AHT is due to hypoxic-ischemic injury with hypoxic-ischemic encephalopathy (HIE) rather than primary traumatic brain injury (TBI) with traumatic diffuse axonal injury (tDAI).

Methods

We studied brain tissue of AHT victims. Primary outcome measure was the presence of primary traumatic versus hypoxic-ischemic brain injury. The diagnosis of tDAI followed a standardized semiquantitative diagnostic approach yielding a 4-tiered grading scheme (definite, possible, improbable, and none). In addition, results of quantitative immunohistochemical analysis in a subgroup of AHT victims with instant death were compared with matched SIDS controls.

Results

In our cohort of 50 AHT victims, none had definite tDAI (no tDAI in 30, tDAI possible in 2, and tDAI improbable in 18). Instead, all AHT victims showed morphological findings indicative of HIE. Furthermore, the subgroup with instant death showed significantly higher counts of damaged axons with accumulation of amyloid precursor protein (APP) in the brainstem adjacent to the central pattern generator of respiratory activity (CPG) (odds ratio adjusted for age, sex, brain weight, and APP-count in other regions = 3.1; 95 % confidence interval = 1.2 to 7.7; p = 0.015).

Conclusions

AHT victims in our cohort do not have diffuse TBI or tDAI. Instead, our findings indicate that the encephalopathy in AHT is the due to hypoxic-ischemic injury probably as the result of respiratory arrest due to local damage to parts of the CPG in the brainstem.

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Postmortem wounds caused by cookie-cutter sharks (Isistius species): an autopsy case of a drowning victim

Forensic Science, Medicine, and Pathology  August 2014;   DOI10.1007/s12024-014-9597-9

A woman in her late 50s was found deceased and floating in an ocean bay in a temperate region (N31°33′48″, E130°33′55″) surrounded by wave dissipation blocks. The woman’s appearance was orderly, except for her sweater, which was turned up to her face. Her jacket, shoes, and bag were found on a nearby block. The police investigation ascertained that she suffered from depression and had previously contemplated suicide. No suicide note or farewell letters were found. She was last seen alive, by relatives, approximately 6 days earlier.

Medico-legal autopsy revealed several antemortem abrasions and bruises on the head, one of which was accompanied by mild subarachnoid hemorrhages without cerebral contusions on the right parietal lobe. In addition, the victim showed the typical findings of drowning such as ballooning of the lungs (weight: left, 310 g; right, 380 g) with impressions created by the ribs and so-called “Paltauf spots” on the pleural surface, bilateral pleural effusion

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Distinctive thanatomicrobiome signatures found in the blood and internal organs of humans

Journal of Microbiological Methods Volume 106, November 2014, Pages 1–7;  DOI: 10.1016/j.mimet.2014.07.026

According to the Human Microbiome Project, 90% of the cells in a healthy adult body are microorganisms. What happens to these cells after human host death, defined here as the thanatomicrobiome (i.e., thanatos-, Greek defn., death), is not clear. To fill the void, we examined the thanatomicrobiome of the spleen, liver, brain, heart and blood of human cadavers. These organs are thought to be devoid of microorganisms in a healthy adult host. We report that the thanatomicrobiome was highly similar among organ tissues from the same cadaver but very different among the cadavers possibly due to differences in the elapsed time since death and/or environmental factors. Isolation of microbial DNA from cadavers is known to be a challenge. We compared the effectiveness of two methods by amplifying the 16S rRNA genes and sequencing the amplicons from four cadavers. Paired comparisons revealed that the conventional DNA extraction method (bead-beating in phenol/chloroform/bead-beating followed by ethanol precipitation) yielded more 16S rRNA amplicons (28 of 30 amplicons) than a second method (repeated cycles of heating/cooling followed by centrifugation to remove cellular debris) (19 of 30 amplicons). Shannon diversity index of the 16S rRNA genes revealed no significant difference by extraction method. The present report provides a proof of principle that the thanatomicrobiome may be an efficient biomarker to study postmortem transformations of cadavers.

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Your death microbiome could catch your killer

New Scientist No 2984 28 August 2014 Identity, time of death, cause of death, even whether a corpse has been moved – the body’s trillions of microbes could reveal it allView full-text

Direct penetrating and indirect neck trauma as a cause of internal carotid artery thrombosis and secondary ischemic stroke

Journal of Thrombosis and Thrombolysis Vol 38 no 3  pp 409-415; Oct 2014

The following manuscript presents two cases of ischemic stroke secondary to traumatic internal carotid artery thrombosis with concomitant middle cerebral artery thrombosis occurring very rarely in the medico-legal practice. Penetrating neck trauma due to an occupational accident and multiple head and neck trauma secondary to battery were described. The autopsy and histopathological examination as well as the analysis of available medical records, including radiological examinations, and records of investigation indicated the sustained trauma to be the cause of the thrombosis.

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