American Journal of Forensic Medicine and Pathology最新文献

Abstract: Deaths by homemade suicide machines naturally capture public attention given the sensationalism of the subject matter and the complexity of the mechanisms involved. In this case, a self-made apparatus designed to administer a fatal dose of fentanyl, leading to an intentional acute toxicity, was used. As detailed in his 19-page manifesto discovered posthumously, the decedent engineered this device with the express purpose of testing the Many-Worlds Interpretation of quantum mechanics. This interpretation posits that for every time one outcome is observed, there are "parallel universes" in which a different outcome becomes reality; these "parallel universes" are collectively called the "multiverse." By programming his homemade device to kill the versions of himself in the "parallel universes" where he did not achieve a desired outcome-that is, having the winning numbers of a Powerball lottery drawing-the decedent sought to experience a reality where he did win the lottery, which would somehow through his convoluted logic thereby prove the existence of the "multiverse."Initially, the bizarre details of the scene led investigators to consider possibilities like intentional electrocution or even homicide executed by remote means. Thorough death scene and background investigation was critical to determine that it was an elaborate act of suicide.

Abstract: A 65-year-old man with a history of hypertension and coronary artery disease was found dead at home after having fallen about 6 days prior. Autopsy examination revealed unexplained penetrating trauma of the skull with a circular defect in the frontal bone with associated cerebral laceration and organizing subdural hemorrhage. As the cause of the penetrating injury was unknown, the forensic pathologist instigated further investigation. Through interviews, the medicolegal death investigator identified the primary scene of injury, which was different from the scene of death; she elucidated the injury scenario, including the culprit object, which she photographed during the follow-up investigation. The etiology of the injury allowed the medical examiner to correctly certify manner of death. This case represents an interesting example of penetrating cranial injury, with minimal external injury and extensive internal lethal damage to the brain. Furthermore, it highlights the importance of investigating the primary scene of injury, especially when death is delayed and the deceased is no longer at the injury location.

Abstract: As COVID-19 continues to infect millions of people globally, it is essential to understand how SARS-CoV-2 affects the brain. The purpose of this study is to determine if there are any associations or patterns of gross and microscopic neuropathological autopsy findings in the brains of patients who died from COVID-19. We analyzed 32 autopsy cases that met 3 requirements: (1) positive polymerase chain reaction (PCR) SARS-CoV-2 test at autopsy; (2) pulmonary histological features of SARS-CoV-2; (3) complete autopsies conducted during the COVID-19 pandemic from 2020 to 2023. We accounted for the presence of the following gross and microscopic neuropathological findings: cerebral edema (CE), cerebral cortical atrophy (CCA), chronic cerebrovascular disease (CCD), cerebral ischemic injury (CII), cerebral inflammation (CIN), and/or cerebral parenchymal hemorrhage (CPH) in every case. We found that CE, CCA, and CII diagnoses had a statistically significant association with age. There were no distinctive or recurrent neuropathological alterations in the autopsied brains that may be interpreted to be pathognomonic of SARS-CoV-2 infection in our cohort. These findings may suggest that SARS-CoV-2 infection is not associated with any distinct histomorphologic abnormalities that are diagnostic of COVID-19 in the brains of autopsied patients.

Abstract: The sudden death of a previously healthy infant is a devastating event for a family-the death of 2 even more unimaginable. Prior to the debunking of Meadow's law, a legal concept attributing multiple unexplained infant deaths to Munchausen by proxy, these events could lead to the wrongful prosecution of those who had lost their children to "sudden unexpected infant death (SUID)." Today, these cases, wherein multiple infants within one family pass inexplicably, raise suspicion for a possible genetic cause and point toward a need for postmortem genetic testing.We present the case of 2 siblings who passed suddenly in infancy, with no structural cause of death identified at autopsy. Genetic testing in both infants found the same variant of uncertain significance, a heterozygous single nucleotide substitution, denoted c.3191C>T, in SCN10A, which encodes a sodium channel with pathogenic variants possibly implicated in sudden cardiac death syndromes. Although it is unclear at this time if the variant of uncertain significance identified was a contributing factor in the deaths, the case emphasized the importance of involving a multidisciplinary team to ensure appropriate pretest and posttest counseling, interpretation of nuanced testing results, and medical follow-up for surviving family members of SUID.