Incidental Massive Hydrocephalus Associated With an Unruptured Choroid Plexus Arteriovenous Malformation and Complete Agenesis of the Corpus Callosum Found in an Adult at Autopsy.

Undiagnosed significant hydrocephalus is an uncommon finding at forensic autopsy as many cases present in life with complex neurological symptoms. We present a case of a 46-year-old man with no neurological deficits or history of head trauma that was incidentally found to have a massive hydrocephalus at autopsy. This was found to be associated with an unruptured arteriovenous malformation completely confined to the choroid plexus as well as complete agenesis of the corpus callosum. The arteriovenous malformation was found to form a calcified obstruction at the foramen of Monro analogous to a mass lesion, such as a colloid cyst of the third ventricle. The association of this malformation and agenesis of the corpus callosum has never been described. Histologic examination of the brain confirmed significant loss of white matter tracts and thinning of the cortical ribbon due to pressure atrophy of the ependymal lining without significant gliosis, cortical dysplasia, or evidence of other developmental malformations. Autopsy is a vital tool in the evaluation of such rare cases, enhances epidemiologic data, and increases the understanding of these pathophysiological associations.

Discordance of Gross and Histologic Findings in Estimating the Range of Fire of Gunshot Wounds.

Forensic pathologist use soot and/or stippling surrounding entrance gunshot wounds in categorizing range of fire. If absent, some pathologists suggest utilizing histology when the range is diagnostically critical. This study investigates the concordance of macroscopic and microscopic findings in estimating range of fire by evaluating gunshot entrance and exit wounds made through human tissue analogs at defined distances using two handgun calibers. Examination of over 150 entrance wounds verified the ease of visually detecting soot from a muzzle distance of contact to 1 foot (30.5 cm), and its absence at 9 feet (274.3 cm). Distinctly apparent was bullet wipe surrounding the entrance wounds regardless of muzzle distance. Although variations existed, dark material was histologically identified in many skin, soft tissue, and bone sections at all ranges with both calibers. These nonparallel results decrease the dependability of histology for range of fire estimation and reinforce using gross observation.

Horticultural Homicide: Stab Wound to the Chest Masquerading as Impalement by Rose Bush.

Instruments that create stab wounds are required to possess tips of sufficient strength and rigidity to breach the integrity of the skin. Knives, the most common weapons used to create stab wounds, have cutting edges that cleave the skin, leaving unabraded margins. On rare occasions, blunt objects are driven with sufficient force to pierce the skin and become impaled within the body. The morphologic differences between the cutaneous injuries and wound tracks of stab wounds from sharp objects and impalement with blunt ones provide clear delineation of the two. However, elements from the scene and obscuring hemorrhage can make initial differentiation difficult. The authors report the death of a 59-year-old woman found near the entryway steps of her home with a stab wound to her chest. Law enforcement did not discover any weapons. Investigation focused on blood around and on a broken rose bush planted near the steps with the belief that the decedent had fallen upon the vegetation. When presented with information that conflicts with autopsy findings, careful consideration of proposed weapons and thorough examination of the wound are required to discount confounding material.