Table Of Content

M. Oehmichen R. N. Auer H.G. König Forensic Neuropathology and Associated Neurology M. Oehmichen R. N. Auer H.G. König Forensic Neuropathology and Associated Neurology With a Foreword by Kurt A. Jellinger With 264 Figures and 69 Tables 123 Manfred Oehmichen Hans Günter König Universitätsklinikum Schleswig-Holstein Universität Tübingen, Institut Rechtsmedizin Institut für Gerichtliche Medizin Kahlhorststrasse 31–35 Eberhardtstrasse 4 D-24562 Lübeck D-72074 Tübingen Germany Germany Arnold-Heller-Strasse 12 24105 Kiel Germany Roland N. Auer Dept. of Pathology and Laboratory, University of Calgary 3330 Hospital Drive NW Calgary Alberta, T2N 4N1 Canada Photo Documentation by Basic Translation by Mrs. Dagmar Angermann James Heywood Institute of Legal Medicine 142 W. 2nd St. University of Lübeck Mesa/AZ 85201 USA ISBN-10 3-540-23500-0 Springer-Verlag ISBN-13 978-3-540-23500-2 Berlin Heidelberg New York Libary of Congress Control Number: 2005924215 The use of general descriptive names, registered names, trademarks, etc. in this publications does not imply, even in the absence of a speci- This work is subjekt to copyright. All rights are reserved, whether the fi c statement, that such names are exempt from the relevant protecti- whole or part of the material is concerned, specifi cally the rights of ve laws and regulations and therefore free for general use. translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfi lms or in any other way, and storage in data Product liability: The publishers cannot guarantee the accuracy of any banks. Duplication of this publication or parts thereof is permitted information about dosage and application contained in this book. In only under the provisions of the German Copyright Law of September every individual case the user must check such information by consul- 9, 1965, in its current version, and permission for use must be obtai- ting the relevant literature. ned from Springer-Verlag. Violations are liable to prosecution under the German Copyright Law. Editor: Gabriele Schröder, Heidelberg Desk Editor: Stephanie Benko, Heidelberg Springer is a part of Springer Science+Business Media Typesetting: Satz-Druck-Service, Leimen Production: Pro Edit GmbH, Heidelberg springeronline.com Cover-Design: Frido Steinen-Broo, EStudio Calamar, Spain Printing and Binding: Stürtz, Würzburg © Springer-Verlag Berlin Heidelberg 2006 Printed in Germany Printed on acid-free paper 24/3151Re 5 4 3 2 1 0 Foreword Partly as a result of major recent advances in neu- forensic neuropathologist to differentiate naturally robiology and molecular sciences, but also as a con- occurring disorders from non-natural and exog- sequence of improving methods in clinical neuro- enous ones, and he needs extensive experience in sciences, general and forensic pathology, forensic order to avoid misinterpretation of cerebral lesions, neuropathology has become a highly specialized which becomes more and more difficult with our field of modern medicine, which deals with disor- increasing knowledge of the pathology and patho- ders of the nervous system under non-natural, trau- genesis of nervous system disorders, the etiology of matic, exogenous or criminal conditions. Although which remains to be elucidated. On the other hand, forensic neuropathology has a long tradition, lead- basic and clinical neuropathologists not experi- ing from C.B. Courville (1964) via Leestma (1988), enced in forensic problems often may not be able to and Unterharnscheidt (1992−94) to Manfred Oeh- differentiate naturally developing disorders from michen, and is of eminent importance within the forensic ones, while many forensic pathologists are field of forensic sciences, this particular and com- not acquainted with the current neuropathological plicated subject has received only little attention literature. The present book, the first one on foren- within the scientific community. With greater and sic neuropathology after almost two decades, and more precise understanding of the pathological, the first written by German scientists after Unter- physical, biochemical, and molecular genetic proc- harnscheidt’s handbooks of traumatic lesions of the esses involved in disorders of the nervous system brain and spinal cord, closes a broad gap between and their relations with causes of death under natu- clinical and forensic neuropathology. The coverage ral and non-natural circumstances, the prospects of the topics listed in the table of contents is com- of new forms of investigation into fatal processes prehensive and complete. After dealing with general are becoming more practicable. Based on lifelong aspects and basic mechanisms of molecular neuro- experience in the field of general forensic medicine science, it reviews the major disorders of the central and, in particular, forensic pathology and neuropa- and peripheral nervous system with impact on le- thology, Forensic Neuropathology and Associated sions most frequently observed in forensic medicine, Neurology, written by Manfred Oehmichen, Roland i.e., physical, ischemic/hypoxic, and toxic damage N. Auer, and Hans Günter König presents a timely to the nervous system of adults, and especially of overview of the state-of-the-art of examination and infants and children, but also naturally occurring clarification of diseases of the nervous system un- disorders of the nervous system, including vascu- der general and forensic circumstances. Like gen- lar, metabolic, toxic, degenerative, and age-related eral pathology and neuropathology, its forensic part diseases, all handled in a well-written, concise, and serves not only to clarify the causes of death due didactic way. The book is based on the senior au- to nervous system disorders, but it is an important thor’s vast experience in his particular profession, method for quality control excluding natural causes and will provide the reader with a state-of-the-art of death. Thus, forensic neuropathology, based on overview of forensic neuropathology. The illustra- recent results, guidelines and standards of modern tions, as one would expect in a Springer book, are pathology and neurosciences, has become an inte- outstanding, and the reference lists added to each gral part of forensic medicine and practice. chapter are informative. The concept and the structure of the book is Speaking as one who has spent much of his life- based on the principles of forensic neuropathology, time in neuropathology and applied neurosciences modern cytology, cell and tissue reactions, modern and as a close friend to the senior author of this sem- biophysics, and molecular biology of the nervous inal book, I am glad to note that it covers practically system. It is an important and difficult task for the the whole field of neuropathology with impact on VI Foreword forensic problems. I am happy to recommend this professionals will find much information within its outstanding volume as a first-rate reference book pages. I am confident that this outstanding and dis- to a wide audience of forensic scientists, general pa- tinguished textbook is assured of full success. thologists, clinical neuropathologists as well as to neurologists, neuropediatrists, and psychiatrists, K.A. Jellinger, MD and other health professionals interested and en- Professor of Neurology and Neuropathology, gaged in forensic problems of disorders of the nerv- Medical University of Vienna ous system. Indeed, many physicians and health Senior Editor-in-chief of Acta Neuropathologica Preface The present textbook was written with the same in- sician. We hope the reader will find this approach tentions as Leestma introduced his excellent mono- unique and useful, as well as intriguingly broaden- graph (Forensic Neuropathology. Raven, New York, ing the horizons of what is usually discussed under 1988), “to deal with those areas which have the most medicolegal headings and topics. importance in forensic settings, are typical problem The clinical aspects are discussed since forensic areas, or seem to be poorly understood by most fo- pathologists are increasingly asked to aid in medico- rensic pathologists….” The authors have attempted legal questions in connection with medical lawsuits. not only to describe the pathomorphology of insults On the other hand we have lost sight of the needs of of the human nervous system, but also the underly- clinical neurologists, neurosurgeons, neuropediatri- ing pathophysiological, molecular, and biomechani- cians, neurotraumatologists, and neuroradiologists, cal principles that can help forensic pathologists to who may also be called to serve as expert witnesses understand the pathological changes induced by a in court. Thus we offer essential information on the traumatic event and enable the expert witness to pathological processes encountered in survivors reconstruct the criminal act; they have tried to in- of different brain injuries. The present book may tegrate the forensic and criminalistic problems and therefore be a useful tool for both pathologists and questions as well as − to a certain degree − the clini- clinicians confronted with forensically relevant in- cal features and sequelae. The aim of this volume is juries and disorders of the human nervous system. to bridge the gap between the ways of thinking of the basic neuroscientist, the researcher, the practicing medicolegal neuropathologist, and the clinical phy- M. Oehmichen, R.N. Auer, H.G. König