Discrepancy of clinical symptoms and prognosis of a patient — forensic significance of “talk and die” head injury

Kibayashi, Kazuhiko; Ng’walali, Paul M.; Hamada, Kisei; K, Honjyo; Tsunenari, Shigeyuki

doi:10.1016/s1344-6223(00)80021-8

Cited by 8 publications

(7 citation statements)

References 13 publications

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“…The serial sections were silver stained by Gallyas and modified Bielschowsky methods; the former has a high sensitivity for NFTs and the latter stains both NFTs and SPs [12,13]. IHC was performed on the sections with monoclonal antitau antibodies that recognize phosphate-independent epitopes (clone T14, Zymed, USA, ready-to-use; clone Tau 2, Novocastra, UK, dilution 1:50), polyclonal anti-tau antibody that reacts with phos- and monoclonal anti-beta-amyloid (clone 6F/3D, Novocastra, UK, dilution 1:20) using a labeled streptavidin-biotin method as described previously [3,14]. Histology sections were examined without knowledge of the medical history and autopsy findings in each case.…”

Section: Methodsmentioning

confidence: 99%

“…Patients with AD are at risk of accidents such as falls, traffic mishaps, house fires and hypothermia because of cognitive dysfunction and abnormal behavior such as aimless wandering. In a forensic autopsy of an elderly person, a neuropathological examination may confirm the clinical diagnosis of AD and determine the cause of an accident [3,4,5]. The neuropathological diagnosis of AD is based on the histological findings of the cerebral neocortexes in frontal, temporal and parietal lobes.…”

Section: Introductionmentioning

confidence: 99%

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Heat-induced immunoreactivity of tau protein in neocortical neurons of fire fatalities

Kibayashi

Shojo

2003

International Journal of Legal Medicine

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Tau protein is the main component of neurofibrillary tangles of Alzheimer's disease (AD). Immunohistochemistry of tau protein is useful in the diagnosis of AD but produces diffuse staining of neocortical neurons in fire fatalities. To learn the cause of this phenomenon, we examined the temporal neocortex of 13 fire fatalities and 9 fatalities unrelated to fire. The diffuse tau immunoreactive neurons were observed in 10 fire fatalities with heat coagulation of the cerebrum. Diffuse staining was not found in the three fire fatalities without heat coagulation of the cerebrum or in fatalities unrelated to fire. The immunoreactivity progressively increased as a function of the degree of cerebral heat coagulation. These results demonstrate that diffuse tau immunoreactivity of neocortical neurons is a post-mortem phenomenon caused by prolonged exposure of the head to intense heat. Forensic pathologists should consider this phenomenon when they diagnose AD in fire fatalities.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Heat-induced immunoreactivity of tau protein in neocortical neurons of fire fatalities

Kibayashi

Shojo

2003

International Journal of Legal Medicine

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“…ND prediction with admission VS, age, sex and GCS score was moderately accurate, confirming the importance of a thorough clinical assessment upon arrival to the hospital. GCS is a robust neurological assessment tool; however, early presentation can be deceiving, with many low energy falls resulting in brain hemorrhage and swelling, resulting in increased ICP and greater risk for severe disability and death ( 29 – 33 ). Additionally, the inter-rater reliability of GCS measurement is variable, and may be influenced by level of training and experience of the individual making the assessment ( 34 – 36 ).…”

Section: Discussionmentioning

confidence: 99%

Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury

Melinosky

Yang

et al. 2018

Front. Neurol.

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Background: In the acute resuscitation period after traumatic brain injury (TBI), one of the goals is to identify those at risk for secondary neurological decline (ND), represented by a constellation of clinical signs that can be identified as objective events related to secondary brain injury and independently impact outcome. We investigated whether continuous vital sign variability and waveform analysis of the electrocardiogram (ECG) or photoplethysmogram (PPG) within the first hour of resuscitation may enhance the ability to predict ND in the initial 48 hours after traumatic brain injury (TBI).Methods: Retrospective analysis of ND in TBI patients enrolled in the prospective Oximetry and Noninvasive Predictors Of Intervention Need after Trauma (ONPOINT) study. ND was defined as any of the following occurring in the first 48 h: new asymmetric pupillary dilatation (>2 mm), 2 point GCS decline, interval worsening of CT scan as assessed by the Marshall score, or intervention for cerebral edema. Beat-to-beat variation of ECG or PPG, as well as waveform features during the first 15 and 60 min after arrival in the TRU were analyzed to determine physiologic parameters associated with future ND. Physiologic and admission clinical variables were combined in multivariable logistic regression models predicting ND and inpatient mortality.Results: There were 33 (17%) patients with ND among 191 patients (mean age 43 years old, GCS 13, ISS 12, 69% men) who met study criteria. ND was associated with ICU admission (P < 0.001) and inpatient mortality (P < 0.001). Both ECG (AUROC: 0.84, 95% CI: 0.76,0.93) and PPG (AUROC: 0.87, 95% CI: 0.80, 0.93) analyses during the first 15 min of resuscitation demonstrated a greater ability to predict ND then clinical characteristics alone (AUROC: 0.69, 95% CI: 0.59, 0.8). Age (P = 0.02), Marshall score (P = 0.001), penetrating injury (P = 0.02), and predictive probability for ND by PPG analysis at 15 min (P = 0.03) were independently associated with inpatient mortality.Conclusions: Analysis of variability and ECG or PPG waveform in the first minutes of resuscitation may represent a non-invasive early marker of future ND.

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“…The speed of the collision also affects the nature of the accident: a person will generally end up in front or to the side of the vehicle in a low-speed collision (with the vehicle moving around 20 km/h), tossed up onto the hood or front windshield of the vehicle in a medium-speed collision (with the vehicle moving 20-60 km/h), and thrown into the air and then brought to the ground in a high-speed collision (with the vehicle moving 60-100 km/h). A low-speed collision often results in the pedestrian being run over by the vehicle involved, while highspeed collisions can cause severe head trauma when the pedestrian hits the road surface [1,3,11,14].…”

Section: Physical Damage Caused By Traffic Accidentsmentioning

confidence: 99%

“…In the event of a sudden, unexpected death of a driver, investigators often perform an autopsy to differentiate the death from a normal traffic accident fatality. However, diseases and symptoms that may affect the driving performance of a driver seldom become the subjects of forensic medical examinations; although they may help trigger traffic accidents, they almost never actually cause the death of a driver operating a vehicle [3,4,5,6,7,10].…”

Section: Diseases and Drivingmentioning

confidence: 99%

Fatal traffic accidents and forensic medicine

2014

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a b s t r a c tIn the event of a traffic accident fatality, the death is reported as an "unusual death," an inquest is conducted, and, if necessary, a forensic autopsy is performed to prove any causal relationship between the accident and the death, identify the vehicle at fault, and determine the cause of the accident. A forensic autopsy of a traffic accident fatality needs to both determine the cause of death and identify the mechanism of injury, an analytical task that requires observation of three major traffic accident factors: the body, the vehicles involved, and the scene of the accident. Also crucial to determining the cause of death is the process of looking into whether the people involved in the accident had any diseases that might affect their driving performance or were under the influence of alcohol or drugs. In order to reduce the number of people killed in traffic accidents, it will be important to promote joint research uniting forensic medicine, clinical medicine, automotive engineering, and road engineering, take measures to limit the impact of inebriated pedestrians and pedestrians suffering from dementia, and ensure proper screening of alcohol and illegal drug consumption in drivers.

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Discrepancy of clinical symptoms and prognosis of a patient — forensic significance of “talk and die” head injury

Cited by 8 publications

References 13 publications

Heat-induced immunoreactivity of tau protein in neocortical neurons of fire fatalities

Heat-induced immunoreactivity of tau protein in neocortical neurons of fire fatalities

Continuous Vital Sign Analysis to Predict Secondary Neurological Decline After Traumatic Brain Injury

Fatal traffic accidents and forensic medicine

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