Biomedical subjects

Joseph A Prahlow

Publications and source records attributed to Joseph A Prahlow.

16 recordsLinked to original sources

PubMed2006

Sudden infant death due to neurofibromatosis type I.

Sudden infant death syndrome (SIDS) is the unexpected death of an infant under the age of 1 year, where a complete autopsy, including scene investigation, fails to reveal a cause of death. Although the frequency of SIDS has decreased almost 50% over the past 10 years, it remains the leading cause of death in infants aged 1 to 6 months. SIDS is a diagnosis of exclusion and requires the elimination of a wide range of possible causes, including asphyxia, poisoning, abuse, occult heart disease, and other natural disease processes. In this report, we describe the case of an infant death initially suspected to be a SIDS death in which autopsy revealed an optic pathway glioma (optic glioma or hypothalamic glioma) and other stigmata of neurofibromatosis type I.

Autopsy↗

PubMed2005

Syphilitic coronary artery ostial stenosis resulting in acute myocardial infarction and death.

Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections. Most notable in this regard is syphilitic aortitis, which tends to result in aortic root dilatation and its associated complications. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. Herein, we present the case of a 32-year-old female who died of a myocardial infarct due to coronary artery ostial stenosis secondary to syphilitic aortitis.

Adult↗

PubMed2005

Death due to Ehlers-Danlos syndrome type IV.

Ehlers-Danlos syndrome (EDS) represents a group of collagen connective tissue disorders characterized by joint laxity, easy bruising, and various skin manifestations. Persons with type IV EDS are at risk for gastrointestinal, uterine, and arterial rupture. Mutations in the COL3A1 gene that encodes for type III procollagen underlie the pathologic abnormalities. Forensic pathologists must be aware of this rare, autosomal-dominant connective tissue disorder. Postmortem diagnosis is possible but requires specialized testing (fibroblast culture and subsequent biochemical assays, with or without molecular studies). When the condition is diagnosed or suspected at autopsy, it is important for forensic pathologists to notify family members of this potentially lethal disorder. Three cases of type IV EDS diagnosed by forensic pathologists are presented, followed by a discussion of the disorder.

Adult↗

PubMed2005

Amitriptyline abuse and misuse.

Deaths related to amitriptyline toxicity are relatively common and are typically related to suicidal overdose. A less well-recognized situation of amitriptyline intoxication occurs when the drug is abused for its euphorigenic effects. An amitriptyline-related death due to a mixed drug intoxication is presented. Death investigation revealed that the death was accidental rather than suicidal. The case serves to remind forensic investigators that not all amitriptyline overdose deaths represent suicides. A segment of the population is known to abuse amitriptyline.

Adult↗

PubMed2005

Sudden death due to asphyxia by esophageal polyp: two case reports and review of asphyxial deaths.

Asphyxia, not an uncommon cause of sudden death, may result from numerous etiologies. Foreign-body aspiration and strangulation are 2 extrinsic causes. Airway obstruction may also be caused by laryngeal edema, asthma, infection, or anaphylaxis. Chronic causes of asphyxia include musculoskeletal diseases (eg, muscular dystrophy, amyotrophic lateral sclerosis), neurologic disorders (eg, myasthenia gravis, multiple sclerosis), respiratory disease (eg, emphysema, chronic bronchitis), or tumors. The manner of death in cases of asphyxiation may be natural, accidental, homicide, or suicide. For the death investigator, determining the cause and manner of death can often be quite challenging. We report here 2 cases of an esophageal fibrovascular polyp causing sudden asphyxial death, review of the literature, and discussion of other differential diagnoses in the case of asphyxial death.

Adult↗

PubMed2005

A suicide using a homemade carbon monoxide "death machine".

Deaths related to carbon monoxide (CO) poisoning are common. Most represent accidents and suicides, and most result from CO production via the incomplete combustion of carbon-containing substances. Suicide via CO toxicity is not uncommon and typically involves the use of motor-vehicle exhaust as a source of CO. Presented herein is a case of suicidal CO poisoning in which the CO was produced via a chemical reaction between formic acid and sulfuric acid within a homemade device.

Adult↗

PubMed2005

West Nile virus encephalitis.

West Nile virus (WNV) is a mosquito-borne virus that has caused a large number of deaths in the United States since the first outbreak in New York City in 1998. The outbreak initially was limited to the northeast but has since spread across the entire continental United States. WNV causes a variety of clinical symptoms, but the most severe consequences result from central nervous system infection, resulting in meningitis, encephalitis, or meningoencephalitis. We present a case of a 62-year-old male with metastatic cancer, who died as a result of WNV encephalitis. This is followed by a discussion on the epidemiology of WNV and a detailed summary of the methods and resources available to make a diagnosis of WNV infection postmortem. The material presented in the discussion should provide the forensic pathologist with all the information necessary to make a diagnosis of WNV infection postmortem. If nothing else, the routine collection and storage of serum, cerebrospinal fluid, and tissue for every case can enable the forensic pathologist to make this diagnosis even in cases in which WNV is not suspected until after autopsy.

Brain↗

PubMed2004

Pregnancy-related maternal deaths.

Pregnancy is a normal biologic process, but because of a variety of physiologic factors, it increases a woman's risk for death. Maternal deaths in pregnancy may be due to conditions unique to pregnancy, conditions associated with pregnancy, or conditions unrelated to but exacerbated by pregnancy. Death may occur during any trimester, during labor/birth, or postpartum. In this report, we present 45 cases of pregnancy-related maternal deaths that were investigated and autopsied at the Dallas County Medical Examiners office between 1977 and 1999, and we review the topic of pregnancy-related maternal death.

Adolescent↗

PubMed2004

"Homicide by heart attack" revisited.

The sudden death of a person caused by an arrhythmia that is induced by physical and/or emotional stress provoked by the criminal activity of another person is sometimes referred to as "homicide by heart attack." Published criteria for such an event relate to situations where no physical contact occurs between the perpetrator and the victim. Situations involving physical contact, but with absence of lethal injuries, are frequently treated is a similar fashion by forensic pathologists. Herein, we propose a set of modified criteria, which include cases where physical contact has occurred. Five examples of so-called "homicide by heart attack" are presented, including a 40-year-old man who was struck in the head with a wooden statue, a 74-year-old man who was punched in the jaw by a robber, a 66-year-old woman who was started awake by a home-intruder, a 67-year-old woman who struggled with a would-be purse-snatcher in a parking lot, and a 52-year-old man who was in a physical altercation with a younger man. In each instance, autopsy revealed the presence of severe, underlying heart disease, as well as absence of lethal injuries. In each case, investigative information was such that the emotional and/or physical stress associated with the criminal activity of another individual was deemed contributory to the death. The presumed mechanism of death in each case was a cardiac dysrhythmia related to underlying heart disease, but initiated by the emotional and/or physical stress.

Adult↗

PubMed2004

Motor-vehicle collision-related death due to delayed-onset subarachnoid hemorrhage associated with anticoagulant therapy.

Delayed deaths following injury are not rare. Various mechanisms may be responsible for such deaths, including pulmonary thromboembolism, fat embolism, infection, systemic inflammatory response syndrome, and delayed hemorrhage. In the present case, we describe a death due to delayed subarachnoid hemorrhage following a motor vehicle collision, wherein the hemorrhage occurred ten days after the incident, while the patient remained hospitalized for skeletal trauma. At no time prior to the hemorrhage did the victim show any symptoms of brain injury. Autopsy revealed basilar subarachnoid hemorrhage arising from a cerebral cortical contusion. There was no evidence of aneurysm or arteriovenous malformation. A significant underlying contributing factor in the delayed hemorrhage was the victim's chronic anticoagulant therapy, which was required because of a mechanical heart valve.

Accidents, Traffic↗

PubMed2004

Homicidal cerebral artery aneurysm rupture.

When a normally natural mechanism of death is induced by physical injury or intense emotional stress, it is appropriate to rule the manner of death as something other than natural. When the case-specific circumstances are such that the death occurs as a result of the criminal activity of another person, it is acceptable to rule such deaths as homicides. Presented herein is a case of homicidal cerebral artery aneurysm rupture occuring in an intoxicated, 46-year-old man who was punched in the face by another individual. The details of the case are presented, followed by a discussion of the controversies that exist when dealing with such cases. Guidelines for investigating similar deaths are presented, with emphasis on the timing of the trauma in relation to onset of symptoms due to aneurysm rupture.

Alcoholic Intoxication↗

PubMed2004

Accidental insulin overdose.

Exogenous insulin has been used for many years to treat diabetes mellitus. Due to the complex nature of insulin therapy, there have been numerous accidental overdoses by these patients. Unfortunately, in other instances, insulin has been used as an agent for suicide and homicide in diabetics as well as nondiabetics. Presented here is a fatal case of accidental insulin overdose in a nondiabetic. Following the case presentation, we review insulin pharmacology and the methods of diagnosing insulin overdose postmortem. In any case of insulin overdose, a comprehensive scene investigation to document the amount and type of insulin used, along with information revealing the source of the insulin is critical. In addition, a complete autopsy, including appropriate laboratory studies, is needed to make a diagnosis in these cases. Proper attention should be given to collection and storage of blood samples, as these specimens often yield the strongest evidence of insulin overdose.

Accidents↗

PubMed2003

Pseudo-gunpowder stippling caused by fragmentation of a plated bullet.

In this report we present a case of pseudo-gunpowder stippling caused by fragmentation of a plated bullet. Investigation of the incident revealed absence of an interposed target, no evidence of ricochet, and a normally functioning, undamaged weapon. Electroplated ("plated" or "coated") bullets are relatively uncommon. They look similar to jacketed bullets in that the lead core is covered by a copper-colored jacketlike material. However, the copper-colored plating material is thinner than the typical jacket material. In certain instances, the plating may strip away from the lead core during transit through the barrel of the weapon and can produce injuries that mimic gunpowder stippling. Forensic pathologists are advised to be aware of this phenomenon. Misinterpretation of such wounds could result in improper classification of range of fire or improper conclusions about the presence or absence of an interposed target or ricochet.

Adolescent↗

PubMed2002

Death resulting from ruptured cerebral artery aneurysm: 219 cases.

To characterize the demographics of ruptured cerebral artery aneurysm as a cause of death and to examine the effect of improved diagnostic and therapeutic techniques on the incidence of sudden death associated with the condition, the authors reviewed 219 autopsies performed at the Dallas County Medical Examiner's Office between 1977 and 1997 in which the cause of death was ruptured cerebral artery aneurysm. Ruptured cerebral artery aneurysms accounted for 1.5% of 15,033 natural deaths and 0.4% of all deaths (45,492) followed by autopsy during this period. The majority (56%) of cases occurred in females, with Caucasian females composing the largest group (38%). Seventy-seven percent of cases occurred in individuals between the ages of 31 and 70 years, with the highest concentration in the 41- to 50-year decade (29%). The most common location for ruptured aneurysms was the middle cerebral artery distribution (39%). Multiple aneurysms occurred in 22 (9.1%) cases. Other factors, such as medical history, coexisting disease, symptoms, activity at onset of symptoms, survival time, and toxicology results are also presented. Compared with literature reports before 1980, when ruptured cerebral artery aneurysms were reported as the cause of death in approximately 4% to 5% of sudden natural deaths, the results of this study suggest that despite improved diagnostic and therapeutic techniques during the past two decades, morbidity and mortality from ruptured aneurysms remain a significant health problem.

Adult↗

PubMed2002

Neurocysticercosis.

Neurocysticercosis results when the ingested eggs of the pork tapeworm, Taenia solium, hatch into larval forms that penetrate the gut wall, disseminate hematogenously, and then encyst in the brain. The subsequent symptoms and associated morbidity are variable. Worldwide, cysticercosis is the most common parasitic disease affecting the central nervous system, but it is not a common autopsy finding in the United States. Neurocysticercosis may be an incidental finding, a contributing cause of death, or the underlying cause of death. It is also important for the forensic pathologist to be aware of the possibility of neurocysticercosis in the autopsy population for purposes of epidemiology studies and infection control. The authors use cases of neurocysticercosis found at autopsy at their institution to give examples of each scenario and to review the clinical and pathologic features of this parasitic disease.

Adult↗

PubMed2002

Suicide by drowning: a 20-year review.

Drowning as a method of suicide is known to occur, but has primarily been described in environments with readily available access to water, such as coastal regions. In this study, we describe and analyze a series of suicidal drownings occurring in a noncoastal area of Texas. Between 1977 and 1996, 52 cases of suicidal drowning were investigated at the Southwestern Institute of Forensic Sciences in Dallas, Texas. Such deaths accounted for only 0.85% of all suicides and 4% of all drowning deaths. In contrast. suicidal drownings reportedly account for 2.8 to 8.9% of all suicides in regions with easy access to water. As with other studies of suicidal drowning, the victims are usually sober white males over the age of 40 years. Our results also confirm that certain individuals who commit suicide by drowning use weights to facilitate the process. A detailed analysis of the cases is provided. as is a synopsis of several questions that may aid in determining the manner of death in suicidal drowning cases.

Adult↗