Examining the decomposed brain

Examination of the decomposed brain is a largely neglected area of forensic neuropathology. However, careful examination often yields valuable information that may assist in criminal proceedings. Decomposition encompasses the processes of autolysis, putrefaction, and decay. Most decomposed brains will be affected by both autolysis and putrefaction, resulting in a brain that may, at one end of the spectrum, be almost normal or, at the other end, pulpified, depending on the conditions in which the body remained after death and the postmortem interval. Naked eye examination may detect areas of hemorrhage and also guides appropriate sampling for histology. Histological appearances are often better than what would be predicted from the state of the brain. Histology often confirms macroscopic abnormalities and may also reveal other features such as ischemic injury. Silver staining demonstrates neuritic plaques, and immunocytochemistry for β-amyloid precursor protein and other molecules produces results comparable with those seen in well-preserved fixed brains. The usefulness of information derived from the examination of the decomposed brain in criminal proceedings is illustrated with 6 case reports drawn from the author's own practice.