Office of the Associate Chief Medical Examiner

Frankfort, KY, United States

Office of the Associate Chief Medical Examiner

Frankfort, KY, United States
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PubMed | State Medical Examiner Office, Norton Neuroscience Institute and Office of the Associate Chief Medical Examiner
Type: Case Reports | Journal: Journal of forensic sciences | Year: 2016

Excited delirium denotes a life-threatening medical condition characterized by the acute onset of agitated and violent behavior that often results in a sudden and unexplained death. Cocaine-induced excited delirium refers to fatal cocaine intoxication with the following symptoms occurring sequentially: hyperthermia, delirium with agitation, respiratory arrest, and death. We present a case of cocaine-induced excited delirium in a cocaine body packer or a mule, specifically an individual who attempts to smuggle cocaine within the body. Investigators at the scene initially suspected homicide due to the victims sharp and blunt force injuries. Three rubber packets containing cocaine were removed from the victims rectum. Blood toxicological analysis revealed an alcohol concentration of 0.016g/100 and cocaine >1mg/L. The forensic pathologist should consider cocaine-induced excited delirium when an individual exhibits aggressive behavior, unexpected strength, and resistance to pain who dies suddenly. Further analysis should be performed during the scene investigation and autopsy for evidence of body packing.

Shields L.B.E.,Norton Neuroscience Institute | Rolf C.M.,Office of the Associate Chief Medical Examiner | Rolf C.M.,University of Kentucky | Davis G.J.,Office of the Associate Chief Medical Examiner | Hunsaker III J.C.,Office of the Associate Chief Medical Examiner
Journal of Forensic Sciences | Year: 2010

Ehlers-Danlos syndrome (EDS) type IV is a connective tissue disorder characterized by the inability to produce sufficient amounts of collagen or a defect in the structure of collagen. The most serious complications include a rupture of a viscus or vascular rupture with or without mural dissection. Death may result from internal hemorrhage. This report describes three cases of sudden and unexpected death caused by EDS type IV. Two cases involved hemothorax as a result of dissection of the subclavian artery and aorta, respectively. The third case represented spontaneous pulmonary rupture and hemorrhage. A detailed family history should be sought, and additional specimens collected to confirm the diagnosis, including skin fibroblasts for collagen testing and blood for DNA testing. The forensic pathologist should consider the possibility of EDS type IV upon discovery of spontaneous visceral or arterial rupture and should alert the family members of this hereditary and potentially fatal condition. © 2010 American Academy of Forensic Sciences.

Shields L.B.E.,Norton Neuroscience Institute | Burge M.,Office of the Associate Chief Medical Examiner | Burge M.,University of Kentucky | Hunsaker III J.C.,Office of the Associate Chief Medical Examiner | Hunsaker III J.C.,University of Kentucky
Forensic Science, Medicine, and Pathology | Year: 2012

Classical polyarteritis nodosa (cPAN) refers to a rare, potentially fatal systemic transmural necrotizing vasculitis that usually affects medium-sized, and occasionally small, muscular arteries, primarily involves the kidneys, gastrointestinal tract, skin, nervous system, joints, and muscles, and is rarely, if ever, expressed in the lungs. The incidence of mortality has significantly decreased with recently developed treatment modalities, in particular antiviral medications. Sudden death due to previously undiagnosed cPAN is rarely encountered. We report a case of a young man who had been evaluated on three occasions by medical personnel in the 3 weeks prior to his death. He had complained of nonspecific symptoms of abdominal and perineal/suprapubic pain, nausea, vomiting, sensation of chilling, and constipation. The spectrum of diagnoses included "gastroenteritis," enteric infection, and prostatitis. Found agonal at home and dying despite immediate cardiopulmonary resuscitation (CPR), he underwent a medicolegal autopsy, which revealed vasculitis of various organs, including heart (myocardium and epicardium) and extramural coronary arteries, liver, spleen, kidneys, adrenal glands, stomach and bowel, omentum, gallbladder, and pancreas. His sudden death was cardiac in nature due to PAN associated clinically with hepatitis B surface antigen positivity (hepatitis B virus-associated PAN [HBV-PAN]). A complete autopsy with thorough histopathological examination is necessary to diagnose this uncommon yet potentially fatal vasculitis. © 2011 Springer Science+Business Media, LLC.

Shields L.B.,Norton Neuroscience Institute | Balko M.G.,Medical Legal Consultants | Hunsaker J.C.,Office of the Associate Chief Medical Examiner | Hunsaker J.C.,University of Kentucky
Journal of Forensic Sciences | Year: 2012

Pituitary tumor apoplexy refers to a clinical syndrome precipitated by the expansion of a pituitary adenoma by hemorrhage or infarction. Individuals may present with myriad signs, including sudden onset of severe headache, visual changes, altered mental status, cranial nerve palsies, and hormonal dysfunction. This disorder constitutes a medical emergency and warrants an expedited evaluation, diagnosis, and treatment to prevent the potential sequelae of permanent visual loss, endocrine abnormalities, or death. We report a case of sudden death from undiagnosed pituitary tumor apoplexy. The decedent was evaluated by medical personnel on three occasions in the week prior to her death for severe headache, nausea, vomiting, and photophobia. Postmortem examination demonstrated a hemorrhagic infarction of a pituitary adenoma with necrosis and expansion out of the sella turcica. The recognition of and treatment for a patient with pituitary tumor apoplexy requires a rapid multidisciplinary effort. Failure of prompt diagnosis may be fatal and require a medico-legal death investigation for sudden and unexpected death. © 2011 American Academy of Forensic Sciences.

Frame M.H.,Office of the Associate Chief Medical Examiner | Schandl C.A.,Medical University of South Carolina
Journal of Forensic Sciences | Year: 2015

Although worker injury and fatalities have decreased since adoption of the Occupational Safety and Health Act in 1970, it remains an important safety issue. This article describes a 27-year-old white male who died from occupational exposure to airborne chemicals. Several trends in the last several decades, both in the types of injuries and the occupations associated with fatalities, are noted. Additionally, individual risk factors such as age, gender, chronic disease, smoking, and alcohol and drug use are implicated in worker health and safety. The role of the forensic pathologist in the investigation of workplace deaths is highlighted, in addition to the future of occupational safety and current improvements brought about by such incidents. © 2014 American Academy of Forensic Sciences.

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