Forensic Neuropathology PDF
Preview Forensic Neuropathology
FORENSIC NEUROPATHOLOGY FORENSIC NEUROPATHOLOGY Second Edition Edited by Helen Whitwell Formerly Professor of Forensic Pathology University of Sheffield and Neuropathologist West Midlands, UK Christopher Milroy Forensic Pathologist and Professor Department of Pathology and Laboratory Medicine University of Ottawa, Canada Daniel du Plessis Consultant Neuropathologist Neuropathology Unit Department of Cellular Pathology and Greater Manchester Clinical Neurosciences Centre Salford Royal Hospital NHS Foundation Trust Liverpool, UK Second edition published 2021 by CRC Press 6000 Broken Sound Parkway NW, Suite 300, Boca Raton, FL 33487-2742 and by CRC Press 2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN © 2021 Taylor & Francis Group, LLC First edition published by Edward Arnold (Publishers) Ltd. 2005 CRC Press is an imprint of Taylor & Francis Group, LLC This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reli- able data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish to make clear that any views or opinions expressed in this book by individual editors, authors or contributors are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or guidance contained in this book is intended for use by medical, scientific or healthcare professionals and is provided strictly as a supplement to the medical or other professional's own judgement, their knowledge of the patient's medical history, relevant manufacturer's instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular individual. Ultimately, it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also attempted to trace the copyright holders of all material reproduced in this publication and apologize to copyright holders if permission to publish in this form has not been obtained. If any copyright material has not been acknowledged, please write and let us know so we may rectify in any future reprint. Except as permitted under US Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any elec- tronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information storage or retrieval system, without written permission from the publishers. For permission to photocopy or use material electronically from this work, access www.copyright.com or contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. For works that are not available on CCC please contact mpkbookspermis- [email protected] Trademark Notice: Product or corporate names may be trademarks or registered trademarks and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging‑in‑Publication Data Names: Whitwell, Helen L., editor. | Milroy, Christopher (Christopher M.), editor. | Du Plessis, Daniel (Daniel G.), editor. Title: Forensic neuropathology / edited by, Helen Whitwell, Christopher Milroy, Daniel du Plessis. Other titles: Forensic neuropathology (Whitwell) Description: Second edition. | Boca Raton : CRC Press, 2021. | Includes bibliographical references and index. | Summary: “Forensic Neuropathology is written by experts for specialists and trainees alike and succeeds in addressing the concerns of the forensic pathologist and the neuropathologist by tackling the overlapping problems that arise during the postmortem examination and subsequent legal proceedings. Totally updated and revised, the new edition contains many new chapters, including much more information on non-accidental injury in pediatric cases, alcohol, sudden death, imaging, sports and transportation injury, long term effects of chronic brain injury and anoxal death”– Provided by publisher. Identifiers: LCCN 2020045920 (print) | LCCN 2020045921 (ebook) | ISBN 9781498706162 (hardback) | ISBN 9781003158035 (ebook) Subjects: MESH: Forensic Pathology–methods | Craniocerebral Trauma–pathology | Central Nervous System–pathology Classification: LCC RA1147 (print) | LCC RA1147 (ebook) | NLM W 825 | DDC 614/.1–dc23 LC record available at https://lccn.loc.gov/2020045920 LC ebook record available at https://lccn.loc.gov/2020045921 ISBN: 978-1-498-70616-2 (hbk) ISBN: 978-0-367-74460-1 (pbk) ISBN: 978-1-003-15803-5 (ebk) Typeset in Utopia Std by KnowledgeWorks Global Ltd. Contents Preface vii 11 Traumatic axonal injury 116 Contributors viii Daniel du Plessis 12 Brain swelling, raised intracranial pressure and 1 Anatomy of the head and neck 1 hypoxia-related brain injury 128 Peter Dangerfield Daniel du Plessis 2 Clinical aspects of head injury 17 13 Sudden unexpected death in epilepsy 139 Graham Flint Christopher Milroy and Daniel du Plessis 3 Imaging of head trauma 25 14 Contact sport and blast-related neuropathology 145 Calvin Soh Daniel du Plessis and Christopher Milroy 4 Biomechanics of primary traumatic head injury 45 15 Head injury in the child 151 Michael Jones Helen Whitwell and Christopher Milroy 5 Techniques 55 16 Spinal injuries 167 Helen Whitwell Graham Flint and Helen Whitwell 6 Scalp, facial and gunshot injuries 66 17 Difficult areas in forensic neuropathology: Christopher Milroy Homicide, suicide or accident 178 Christopher Milroy and Helen Whitwell 7 Adult skull fractures 80 Helen Whitwell and Philip Lumb 18 Non-traumatic neurological conditions in m edico-legal work 186 8 Intracranial haematomas – Extradural and subdural 87 Colin Smith Helen Whitwell 19 Alcohol, drugs, toxins and post-mortem toxicology 195 9 Subarachnoid haemorrhage and cerebrovascular Colin Smith and Christopher Milroy traumatic pathology 94 Daniel du Plessis and Paul Johnson 20 The role of the expert witness 203 Paul Watson and Christopher Milroy 10 Contusional brain injury and intracerebral h aemorrhage – Traumatic and non-traumatic 107 Helen Whitwell Index 208 v Preface This second edition builds on the previous one with the addi- Other chapters especially those on hypoxia, clinical aspects tion of two further co-editors, Christopher Milroy, forensic of head injury, spinal injury, subarachnoid haemorrhage as pathologist from Ottawa who contributed much to the first edi- well as infant head injury have been considerably revised. The tion and Daniel du Plessis, neuropathologist from Manchester. latter now includes a section devoted to ocular pathology. As before, this book is not intended to be a fully compre- New photographs and references are further additional fea- hensive forensic pathology or neuropathology text as there are tures. many available. The aim is to concentrate on those difficult and We hope, as with the previous edition, that readers, includ- emerging areas of forensic neuropathology. These often impact ing forensic pathologists, neuropathologists and general in the medico-legal setting. pathologists, will find this latest text informative and practi- In updating, we have added a number of new chapters, cally useful. Neuroscience clinicians and others will also find including biomechanics, neuroradiology and the important areas of interest. Members of the legal profession found the last topics of chronic traumatic encephalopathy and sudden unex- edition of assistance – including for cross-examination pur- pected death in epilepsy where knowledge has considerably poses – as some of us have experienced! advanced over recent years. vii Contributors Peter Dangerfield Philip Lumb Clinical Anatomist Forensic Pathologist University of Liverpool Manchester, UK Liverpool, UK Colin Smith Graham Flint Neuropathologist Neurosurgeon University of Edinburgh Queen Elizabeth Hospital Scotland, UK Birmingham, UK Calvin Soh Paul Johnson Neuroradiologist Forensic Pathologist Manchester Royal Infirmary Royal Liverpool University Hospital Manchester, UK Liverpool, UK HH Judge Paul Watson QC Michael Jones Circuit Judge Clinical, Trauma and Orthopaedic Engineer Middlesbrough, UK Cardiff University Wales, UK viii 1 Anatomy of the head and neck Peter Dangerfield The surface anatomy and features of the head and neck are associated with hyperthyroidism can result in prominent eyes. derived from skeletal and soft tissue structures covered by skin Facial fractures affecting the maxilla and inferior margin of the and connective tissue that covers the underlying bony skull. In orbit can lead to a sinking of the eyeball. The shape of the lids some areas, particularly the face, the skin is thin, allowing easy themselves can lead to a wide range of different appearances of palpation of underlying skeletal features. It is also highly mobile the eye within the orbit. as a result of the presence of a number of small but extensive subcutaneous muscles of facial expression, all supplied by a The internal facial structures single cranial nerve (facial). The scalp is, in contrast, relatively Internally, the muscles of facial expression and their nerve and tough and hidden from view in most individuals by hair. Within vascular supplies contribute to the facial structures. In addi- the skull, which acts as a protective shield, are the brain and tion, the parotid gland is located within the lateral parts of the brainstem, with its associated covering of tissue layers and cheeks. blood vessels. The anatomy is complex and this chapter can only The facial expression muscles are supplied by the facial provide an overview of the principal features, with craniofacial (cranial VII) nerve. Their function is to control and support anatomy included to link anatomically with the underlying the structures and openings in the face, such as the eyes and structures, including the neuroanatomy, which may be of par- mouth. In humans, their functionality serves an important role ticular significance in penetrating or blunt head trauma. in non-verbal communication as well as aiding actions such as screwing up the eyes and chewing. The mouth is surrounded The external face by the sphincteric orbicularis oris muscle into which merge the fibres of the buccinator, the muscle of the cheek. The buccina- The anatomical surface features of the face are never totally tor contracts during chewing and serves to prevent trapping of symmetrical. As facial expressions have evolved as a commu- food within the space between the gums and teeth; it also acts nication method, the underlying anatomy has evolved from the to raise the pressure of air expelled by musicians playing wind functional need. The skin is often marked by moles and freckles instruments or by whistling. The orbicularis oculi surrounds and may also present with scars consequential to cuts and other the eye and serves to function in two ways. First, fibres that trauma. surround the eye serve to screw the eye up because they are The shape and size of the hairline vary with race and the eye- attached to the bone on the medial aspect of the orbit. Second, brows can also be highly variable. the palpebral fibres attach to the lateral palpebral raphe and The nose comprises underlying cartilaginous and bony serve to close the eye when blinking. Additional fibres are structures. In the coronal section, the nose is triangular in attached to the lacrimal sac and serve to dilate the sac and keep shape. The external nares (nostrils) are protected by coarse the puncta in contact with the eyeball. hairs (vibrissae) and serve to filter air entering the nose. The The facial nerve enters the face by passing through the tough anterior part of the nose is composed of flexible underlying fibrous capsule of the parotid gland and can be damaged during fibrocartilage. surgical procedures to that gland. Inferior to the nose is the mouth, surrounded by the lips. Here, the size and shape of the mouth are very variable, both The nose within races and between different racial groups. The lips have non-keratinised epithelium and thus appear pink as a result of The nose, as the upper part of the respiratory tract, is located the underlying blood vessels. superior to the hard palate and contains the organ of smell. It The eyes are set within the bony orbits of the skull but pro- is divided into right and left nasal cavities by the nasal septum, tected by the rim of bone. Their individual position relative to with each nasal cavity having an olfactory and a respiratory the nose is variable and can be close-set or wide set in normal area. individuals. Attached within the orbits are the muscles that The external nose varies considerably in size and shape in control eye movement while, superficially, the paired eyelids individuals and races because of differences in the nasal car- cover and protect the eye from potential damage. The lids nor- tilage structure. The inferior aspect is composed of two open- mally permit only a portion of white sclera to appear laterally, ings called the nares (nostrils), each separated from the other with the transparent conjunctiva and cornea that cover the pig- by the nasal septum. The nasal bones, the frontal processes of mented iris seen medially. The upper lid normally overlaps the the maxillae, the nasal part of the frontal bone and the bony iris, but the sclera may be seen between the iris and the lower part of the nasal septum form the skeletal components of the lid. The shape of the lids can vary between individuals; in par- nose, whereas five main cartilages form the cartilaginous nose. ticular, the elevator of the upper lid can be weak or damaged, These are two lateral cartilages, two alar cartilages and a septal leading to a drooping appearance. cartilage that articulates with the bony septum. Ethnic differences are often prominent. Mongoloid epican- The nasal cavities open through the choanae into the naso- thic folds and other minor folds of skin in the medial aspect of pharynx at the posterior. The nasal mucosa is bound closely the orbit should be noted. Conditions such as exophthalmos to the periosteum and perichondrium of the nasal bones and
The list of books you might like
