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Significance of inflammatory changes in the brainstem in forensic autopsy cases
S Rogde1, E Kerty, K Skullerud
1Institute of Forensic Medicine, University of Oslo, Norway. sidselr@fagmed.uit.no
Abstract:
Brain stem encephalitis is an uncommon disease. In order to assess the significance of inflammatory changes in the brain stem in a forensic autopsy material we reviewed the findings over a 12-year period. Between January 1st 1982-December 31st 1993, neuropathological examination of the brain was carried out in 29% of the autopsy cases from the Institute of Forensic Medicine, University of Oslo. Out of 4546 brains, 110 (2.2%) showed microglial nodules and perivascular lymphocytic cuffing in the lower brain stem. In 66 of the cases (60%), the abnormalities were limited to the nucleus and/or the spinal tract of the fifth cranial nerve. Only 16 of the 39 cases with more widespread changes, diagnosed as brain stem encephalitis, had a serious underlying or concomitant disease. Three particular cases of brain stem encephalitis are reported in more detail. In all three cases we suggest that the brain stem inflammatory changes may be either the direct or a contributory cause of death.
Insights
Brain stem encephalitis, an uncommon condition, was found in 2.2% of forensic autopsies. Inflammatory brain stem changes were often mild, but in severe cases, they may contribute to death.
Area of Science:
- Neuropathology
- Forensic Medicine
Background:
- Brain stem encephalitis is a rare neurological disorder.
- Assessing its significance in forensic autopsy is crucial.
Observation:
- A 12-year review of 4546 forensic autopsies (1982-1993) was conducted.
- Neuropathological examination revealed inflammatory brain stem changes in 110 cases (2.2%).
- Abnormalities were frequently localized to the trigeminal nerve structures.
Findings:
- Sixty percent of cases with brain stem inflammation showed changes limited to the fifth cranial nerve.
- Of 39 cases diagnosed with brain stem encephalitis, only 16 had significant underlying or concurrent diseases.
- Three detailed case reports suggest inflammatory brain stem changes as a direct or contributing cause of death.
Implications:
- Highlights the importance of neuropathological examination in forensic cases.
- Suggests brain stem encephalitis, even when seemingly localized, warrants careful consideration as a cause of death.
- Underscores the potential for inflammatory brain stem lesions to be fatal in forensic contexts.