[Diagnosis and significance of forensic neuropathological findings]

Among the diseases of the nervous system, Alzheimer-type dementia, head injuries, brain death and fat embolism were discussed on the pathological diagnosis and medico-legal significance. 1. Alzheimer-type dementia 1) There were marked differences in microscopic findings of ATD group and control group of elderly subjects whose intellects have been maintained. The main histological features of ATD were presence of numerous senile plaques and neurofibrillary changes, and both of them were thought to be helpful diagnostic markers. 2) Double stains by GFAP stain and Congo red stain were performed. By the former stain, typical senile plaques, encircled by reactive astrocytes and penetrated interiorly by their processes, were demonstrated. By the latter stain, amyloid core was well detected. By LCA (leucote common antigen) stain, microglias were thronging about amyloid core of senile plaques. By thioflavin S stain, amyloid core and amyloid angiopathy were well detected and some neurofibrillary tangles showed staining properties of amyloid. 3) Using the autopsy criteria for the diagnosis of Alzheimer's disease reported by Khachaturian, senile plaques were counted on microscopic magnification x200 field. Numerous plaques satisfying thoroughly the criteria were detected. 2. Head injuries Old intracranial injuries with long clinical courses were discussed in the aspects of forensic medicine. It can be often understood from postmortem examinations that alterations of personalities, abnormalities of behaviors, and disturbances of visual fields or other senses resulted from the old lesions of their respective territories and pathways in each brain. In forensic medicine, such observations and discussions are very important to clarify the relations between the old intracranial injuries and causes of death. 3. Brain death In cases with the duration of brain death extending over several days, the breakdown of processes of their cerebral astrocytes were shown by GFAP stain. 4. Fat embolism In 62 autopsied cases of fat embolism, fractured bones and survival times after injuries were summarized in tables. In cases of systemic fat embolism, the gross and microscopic findings of brain and spinal cord were discussed.