Birth Related Hemorrhages

In the neonatal period, conjunctival and retinal hemorrhages (and some intracranial hemorrhages) can be the result of nonaccidental injuries (violent shaking, direct trauma) or birth trauma, and careful consideration should be given to this differential diagnosis. Birth-related conjunctival hemorrhages may be documented in delivery or neonatal medical notes charts, or they may be seen on family photographs of a newborn child. Note, however, that their absence may be the result of sampling...

Schizophrenia and Neuroleptic Drugs

An association with excited delirium is but one manifestation of the increased mortality associated with schizophrenia. Patients with this often devastating disorder suffer an increased incidence of natural disease, particularly cardiovascular disorders, as well as deaths by unnatural means (including suicide and accidents).4142 However, attention has increasingly focused upon abnormalities of cardiac rhythm, particularly prolongation of the QT interval. Several antipsychotic agents...

Adrenal Gland

One of the most characteristic morphologic findings in sepsis-related deaths is unilateral or bilateral bleeding in the adrenal cortex. Bleeding may vary in size from tiny focal hemorrhages visible at microscopy (Figure 3.28) to total hemorrhagic infarction (adrenal apoplexy) easily detectable at gross examination. In my experience, adrenal hemorrhages are, in addition to acute splenitis, the most frequent finding in sepsis-related fatalities. Bilateral adrenal hemorrhage (Figure 3.29) in...

References

Necropsy techniques in ophthalmic pathology. ACP Best Practice No. 164. J Clin Pathol 2001 54 417-425. 2. Underwood JCE. Autopsies and clinical audit. In Cotton DWK, Cross SS, editors. The hospital autopsy. Oxford Butterworth-Heinemann, 1993 163-172. 3. The autopsy and audit. Report of the Joint Working Party of The Royal College of Pathologists, The Royal College of Physicians of London and The Royal College of Surgeons of England. London The Royal College of...

Congenital Heart Disease

Despite technical advances, neurologic complications of open heart surgery are estimated to occur in up to 24 of cases.111 The association between SDH and congenital heart disease CHD in infants is related to surgery and the postoperative period rather than a complication of untreated CHD. Humphreys et al.112 drew attention to intracranial hemorrhage occurring in children following open heart surgery for CHD, most frequently valve or congenital cyanotic heart operations. In their series of 16...

Perinatal Hypoxia

Perinatal hypoxia has been considered a risk factor for SDH during birth. However, in a paper on risk factors for intracranial hemorrhage in full-term infants, Jhawar et al.35 draw attention to the earlier publication of Wigglesworth and highlight that this relationship should be considered with caution because the hemorrhage may be secondary to birth trauma, which in turn may precipitate a respiratory crisis and hence the hypoxic event, rather than vice versa, that is, the hypoxic event having...

Skin Subdural Hematoma

Septic Microemboli

Circumscribed bleedings of the skin are a clinically well-known manifestation of DIC during the course of sepsis and are still apparent postmortem on the outer body surface Figure 3.33 . Sometimes these bleedings appear in a discreet petechial pattern, occasionally taking the shape of extensive, confluent hemorrhages. Metastatic spread of septic microemboli may lead to circumscribed cutaneous bleedings in distinct locations Figures 3.34 and 3.35 and must be differentiated from DIC-related skin...

Liver

Pyemic Abscess

The highly complex pathophysiology of the liver in shock is determined by a variety of overlapping inflammatory reactions. At gross inspection, the liver in shock is enlarged, showing a tense Glisson capsule and rounded edges. The weight of the liver in sepsis often is increased because of accumulation of leukocytes and interstitial edema. In septic shock complicated by DIC, spotty hemorrhages are a frequent feature on cut sections. Despite the high incidence of cholecystitis, appendicitis, and...