Fatal hyperthermia in hot baths in individuals with multiple sclerosis

The authors report the case of a 47-year-old black man with a history of multiple sclerosis who was found dead in a bathtub, head above water, with a body temperature of 105.7 F. Results of a complete autopsy and toxicologic screen were negative. Individuals with multiple sclerosis, if immersed in hot water, develop motor weakness, which may be so severe as to prevent them from getting out of the water, whether they be in a bathtub or whirlpool bath. In this case, the individual was trapped in a bathtub in which there was a continuous flow of hot water. This overwhelmed an already impaired thermoregulatory mechanism, causing hyperthermia and death.     

Fatal MDMA-intoxication with postmortem diagnosis of hyperthermia

Hyperthermia is one of the main symptoms of the toxic MDMA effect. In a fatal intoxication, the premortal increase in body temperature may lead to a false assessment of the time of death. The problems of drug-induced hyperthermia faced by forensic pathologists and criminal investigators are discussed on the basis of a death from the autopsy material of the Berlin Institute of Legal Medicine (CCM).     

Fatal malignant hyperthermia associated with recreational cocaine and ethanol abuse

Malignant hyperthermia is an often lethal hypermetabolic crisis state precipitated by a variety of pharmacological and environmental triggers in genetically susceptible persons. The present report documents, by medical history and necropsy, a fatal malignant hyperthermic crisis in a 20-year-old man after an evening of recreational cocaine and ethanol abuse.     

Fatal aspiration of sardine fry in a patient with lung cancer

We report a fatal case of death due to unusual aspiration of sardine fry in an elderly Japanese man with lung cancer. The cause of death was sudden respiratory arrest while eating. Autopsy revealed peculiar materials with cell nests and pigmented particles, together with striated muscle and skin, in the ectatic bronchioles of the left lower lobe. Serial histologic sections suggested that the structures observed were the eyeballs of small animals that appeared to have been inhaled. The patient had habitually eaten sardine fry and rice gruel, which were also detected in the gastric contents. Therefore, the eyes were considered to be those of the fry, which is a popular food item in Japan. This was confirmed by histologic examination of fry that were obtained commercially.     

Fatal intravenous drug abuse secondary to streptomycin overdose

A fatal case of chronic intravenous drug abuse involving the injection of a nonpsychoactive veterinary combination of penicillin G and streptomycin is reported. The circumstances surrounding the death indicate that the decedent died as a result of streptomycin induced paralytic neuromuscular blockade.     

Fatal malignant hyperthermia as a result of ingestion of tranylcypromine (Parnate) combined with white wine and cheese

Fatal malignant hyperthermia occurred in a patient who was taking tranylcypromine (Parnate) and ingested wine and cheese. The case findings are presented along with a review of the literature concerning adverse interactions between monoamine oxidase (MAO) inhibitors and certain foods and beverages. Hyperthermia and its possible causative mechanisms and treatments are discussed. The facts suggest that the complicated dietary restrictions attending the use of MAO inhibitors and the possibility of severe and even catastrophic reactions resulting from violations of these restrictions make the use of these drugs fraught with danger and therefore not a first choice for the treatment of depression.     

Fatal accident with a special automobile

The authors report on a traffic accident in which the passenger of a Light Four-wheeled Vehicle (Microcar) approved for use by a disabled person was killed after a rear collision with a compact car. The severity of the accident trauma was critically determined by the vehicle's light construction. Consideration is also given to the legal situation regarding registration and driver's license issues.     

Causes of unexpected death in patients with multiple sclerosis: a forensic study of 50 cases

To determine the cause of death (as a result of neurologic or nonneurologic complications or accidents) in patients with multiple sclerosis (MS), we reviewed the autopsies of 50 subjects with MS from the Office of the Chief Medical Examiner of Maryland (OCME) between 1982 and 2004. The series included 32 females and 18 males (mean age, 45.8 years; range, 25-69 years) and the causes of death were classified into 3 categories: (A) neurologic complication directly related to MS; (B) nonneurologic complications or other medical causes; and (C) accidents, etc. Of the 50 cases, in 43 there was a history of MS, but in 7 subjects there was not, and the diagnosis was established by neuropathologic examination. In Group A, 21 (42%) cases, deaths were directly related to a neurologic complication; in Group B, 14 (28%) cases were related to the following nonneurologic and medical causes: ASCVD 9 (18%), metabolic disorder 1 (2%), pulmonary embolism 3 (6%), and bronchopneumonia 1 (2%); and in Group C, 15 (30%) cases, deaths were due to trauma, 9 (18%); intoxication, 5 (10%); and thermal injury, 1 (2%). Thus, among the 50 subjects, in 26, deaths occurred naturally; and in 24, from accidents, homicides, suicides, or undetermined causes. Pathologically, the majority of cases showed either chronic inactive (66.7%) or chronic active (15.6%) demyelinating lesions, mainly in the cerebral hemispheres. In some cases, it appears that demyelinating lesions, involving brain regions that regulate cardiorespiratory activity, could be considered as the immediate cause of death, but a large proportion appears to be due to other causes such as accidents and trauma. Thus, it seems likely that taking specific precautions could prevent some deaths in MS.     

Fatal nonatherosclerotic myocardial infarction in a young man with allergic bronchial asthma

A 34-year-old man with allergic asthma died an (instantaneous) sudden cardiac death as a result of multiple myocardial infarcts. These occurred in the absence of coronary atherosclerosis. The major mechanism by which the infarcts occurred was recurrent coronary artery spasm. The latter can occur spontaneously, asthma patients being particularly prone to it. However, various medications prescribed by different physicians may also have played a role.     

Fatal impalement with transfixion of the neck in a road traffic accident

The authors describe a singular case of fatal impalement due to penetration of a metal tube at the level of the neck in a victim of a road traffic accident. The man was traveling in the passenger seat ("death seat") of a car that hit the parapet of a bridge head on; death was attributed to hemorrhagic shock, which was brought on virtually instantly at the moment of impact.     

Death secondary to a donkey's bites

We present a unique case of death due to the assault and bites of a donkey on a 65-year-old man. The farmer, found dead in his farmyard, had a very deep wound in the anterior region of the neck, with a sharp transection of the trachea and severe bleeding by several minor vessels wall disruptions. The cause of death was established to be massive bleeding combined with asphyxia due to aspiration of the blood. Moreover, multiple contusions with associated skin abrasions and perforations were present. The general impression of the injuries was consistent with an animal's bite marks. Herbivorous or omnivorous bite attacks on humans are rare; instead, these animals attack by kicking, trampling, and kneeling, resulting in secondary blunt injuries. The donkey is usually a docile animal, but its behavior can be aggressive during the mating season, and the possibility of biting should not be underestimated, as illustrated by the 2 cases published previously as well as by the case presented here.     

Clustering of multiple sclerosis in Galion, Ohio, 1982-1985

Epidemiologic evidence indicates that the outbreak of 30-40 cases of multiple sclerosis and other demyelinating syndromes in Galion, Ohio, USA, during 1982-1985 was related to an excess concentration of heavy-metal wastes, especially of cadmium and chromium in sewage and river water. Both multiple sclerosis and myasthenia gravis were diagnosed by board-certified neurologists.     

Fatal thrombosis of the basilar artery due to a minor head injury

A case is reported where a 20-year-old alcohol-intoxicated man was admitted to the hospital after a minor head injury. Initially there was no neurologic disturbances or complaints but after a few hours he became comatose, and he died 4 days later without regaining consciousness. The autopsy revealed no lesions of the upper cervical spine or the vertebral arteries, but the basilar artery was occluded in its entire length. No traumatic lesions could be seen by naked eye examination of the artery, and there was no accompanying subarachnoid haemorrhage. A thorough microscopic examination, however, using step-sectioning technique revealed a significant incomplete arterial rupture with an occluding luminal thrombosis superimposed, consisting predominantly of aggregated platelets. Only the very thin adventitia separated the vascular lumen from the subarachnoid space preventing the more well known fatal complication to a minor head injury: A subarachnoid haemorrhage. To the best of our knowledge, fatal thrombosis of the basilar artery due to a minor head injury has not previously been reported. The pathogenetic mechanism seems to be identical to that underlying fatal subarachnoid haemorrhage following a similar trauma apart from the resulting arterial rupture being incomplete instead of complete.     

Endemic clustering of multiple sclerosis in time and place, 1934-1984. Confirmation of a hypothesis

The occurrence of multiple sclerosis in clustered groups of cases that are often related to others in time and place has been observed on several occasions in the last 50 years. Selected clusters are here reviewed in relation to suspected sources of heavy metal (mercury, lead) poisoning as background for the analysis of the 1983-1985 "outbreak" of 30-40 cases of multiple sclerosis in Key West, Florida. Evidence is presented that the time-place clustering resulted from environmental pollution stemming from a nearby dump pile of rocky debris. The probable mechanism is discussed.     

Fatal blunt trauma of the larynx in a child

We report an autopsy case of an 11-year-old girl who suffered mechanical asphyxia from falling off the metal bars in the playground. This autopsy case is interesting because of the atypical trauma and lesions. To our knowledge there has been no similiar published case reports in the forensic literature. The young age of the victim, the setting and the pattern of the injuries are rare in a fall at playground by a child.     

Suicide in a patient with undiagnosed periarteritis nodosa

Surveys of medical examiners' records have shown that as many as one-third of suicide victims have serious physical illnesses. We report the case of a 56-year-old woman who committed suicide by drug overdose. At autopsy, she had severe widespread periarteritis nodosa, which had been unsuspected during life. The identification of treatable physical illness in suicide victims is important in suicide prevention, yet such illness may be overlooked after death unless a forensic autopsy is performed.     

Fatal outcome in a case of pontocerebellar hypoplasia type 2

Pontocerebellar hypoplasia (PCH) is a very rare congenital (autosomal recessive) condition with fetal onset. Only a few cases have been published on the basis of both clinical data (symptoms/neuroradiological imaging) and autopsy results. This paper reports on such a case involving a 1.5-year-old male infant. The child suffered from severe psychomotor delay, extrapyramidal dyskinesia and epileptic seizures, but did not exhibit signs of spinal muscular atrophy as related to PCH type 1. Magnetic resonance imaging (MRI) at the age of 6 months demonstrated olivo-pontine and bilateral cerebellar hypoplasia. The boy was unexpectedly found dead. Autopsy disclosed a severe aspiration of gastric contents as the final cause of death. The neuropathological examination confirmed PCH type 2 (according to Barth [Brain Dev., 15 (1993) 411-422]) with marked microcephaly and olivopontocerebellar hypoplasia. Histologically, decreased density of olivo-pontine neurons, reduction of granular and Purkinje's cell layers of the cerebellum, slight astroglial proliferation and fragmented appearance of the dentate nuclei were observed. The immunohistochemical expression pattern was determined using antibodies against glial fibrillary acidic protein, synaptophysin and neurofilament protein. Summarizing, typical features of PCH type 2 were present and proved by clinical course, MRI and autopsy. Despite severe symptoms due to a natural disease this rare neurogenetic entity can become of forensic interest, when sudden unexpected death occurs.     

Fatal intoxication with a selective serotonin reuptake inhibitor, lorazepam, and codeine

Selective serotonin reuptake inhibitors were introduced in 1987 as an alternative treatment option for patients with depression or certain anxiety disorders. Unfortunately, this greater use has prompted a corresponding increase in reports of more severe side effects and fatalities, with a majority of fatalities occurring due to coingestion of selective serotonin reuptake inhibitors with other substances or serotonergic drugs. We report a case which exemplifies one such fatality related to sertraline, lorazepam, and codeine coingestion. A brief discussion of the presumed mechanism by which death occurred will be offered.