Non-traumatic forensic neuropathology W. Stewart, M. Black, H. Kalimo, D.I. Graham  Forensic Science International  Volume 146, Issue 2, Pages 125-147 (December 2004) DOI: 10.1016/j.forsciint.2004.06.025 Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 1 Autoregulation. This maintains the cerebral blood flow (CBF) at a constant level between the mean arterial blood pressures of approximately 50 and 150mmHg. Above these values the CBF varies with the arterial blood pressure. In hypertensive subjects the curve shifts to the right (dashed line). Reproduced with permission from [43]. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 2 Selective neuronal necrosis. There is a progressive series of events: (a) nerve cells affected by ischaemic cell change are contracted, pyramidal in shape and have pyknotic nuclei, and (b) in addition around the cell bodies there are incrustations (dark dots). In H&E stained sections the cytoplasm is bright red lacking Nissl substance. In Luxol fast blue/cresyl violet (LFB/CV) the cytoplasm is blue, (a) H&E, (b) LFB/CV, 160×. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 3 Dark cell change. This is an artefact of incomplete fixation and excessive handling. Affected neurones (arrows) are dark and contracted and may have long corkscrew-like axons. Compare with Fig. 2. H&E 160×. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 4 Infarction. At 18–24h (a) cortex and (b) white matter. There are irregular areas of pallor of staining. A line separates normal tissue from the infarct (pale areas) becomes apparent. H&E 120×. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 5 Arterial boundary zones (heavy stippling) in the cerebral and cerebellar hemispheres. They lie between the ACA/MCA, MCA/PCA and SCA/PICA territories. ACA = anterior cerebral artery; MCA = middle cerebral artery; PCA = posterior cerebral artery; SCA = superior cerebellar artery; PICA = posterior inferior cerebellar artery. Reproduced with permission from [44]. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 6 Arterial blood supply to the cerebral hemispheres. Reproduced with permission from [45]. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 7 Laminar necrosis after cardiac arrest. There is necrosis of layers III, V and VI (light staining) with relative sparing of layers II and IV (darker staining). Cresyl violet 60×. Reproduced with permission from [46]. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 8 Selective ischaemic neuronal necrosis in hippocampus: (a) normal, (b) there is necrosis of the neurons of the CA1 sector (arched layer between the arrowheads). Cresyl violet 24×. Reproduced with permission from [47]. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 9 Hypoxic damage in cerebellum. Within a few days the Purkinje cells have undergone necrosis (two injured cells marked with arrow) and as a result there is proliferation of microglia and astrocytes in the molecular layer (M). G = granular cell layer. Cresyl violet 120×. Reproduced with permission from [48]. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 10 Central pontine myelinolysis. (a) There is a centrally placed symmetrical area of demyelination in the pons. (b) Same case to show sparing of neurons (three marked with arrow) in the demyelinated region with lipid laden macrophages. (a) Luxol fast blue/cresyl violet 25×. (b) H&E 160×. Part (a) reproduced with permission from [49]. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 11 Hepatic encephalopathy. Alzheimer type 2 astrocytes are recognised by their swollen and vesicular nuclei (three marked with arrow). H&E 200×. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 12 Acquired hepatocerebral degeneration. (a) There are rarefied areas in the globus pallidus (asterisks). (b) There is spongy degeneration in the globus pallidus. (a) Heidenhain for myelin 4×. (b) H&E 120×. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 13 Non-metastatic effects of carcinoma in cerebellum. (a) Subacute cerebellar degeneration: there is loss of Purkinje cells. (b) There are clusters of microglia (arrows) and a reactive astrocytosis in the white matter. G = granular cell layer. M = molecular layer. H&E 60×. Part (a) reproduced with permission from [50]). Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 14 Wernicke's encephalopathy. There are petechial haemorrhages in the mamillary bodies (arrows) and in the walls of the third ventricle. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 15 Subacute combined degeneration of the cord. The loss of myelinated fibers appears as pallor of the sensory posterior columns in the spinal cord (upper two asterisks). The motor lateral corticospinal tracts (lateral two asterisks) are only minimally affected. LFB/CV 5×. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 16 Coronal sections at level of thalamus. (a) Normal brain. (b) Alzheimer's disease: compared with (a) there is atrophy of the insulae and hippocampi with widening of sulci, narrowing of gyri and enlargement of the ventricles. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 17 Alzheimer's disease. There are both β-amyloid protein plaques and neurofibrillary tangles (arrow). Kings method of silver impregnation 200×. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 18 Parkinson's disease. Midbrain. Compared with normal (left) the substantia nigra is pale in case of Parkinson's disease (right). Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 19 Parkinson's disease. Midbrain. Within a pigmented neuron of the substantia nigra there is a Lewy body (arrow). H&E 200×. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 20 Dementia with Lewy bodies. There are many Lewy bodies in the neocortex. Immunohistochemistry for α-synuclein 200×. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 21 Multiple system atrophy of Parkinsonian type (striato-nigral degeneration). Both putamina (arrows) are damaged with greyish discolouration due to accumulation of neuromelanin. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 22 Sporadic Creutzfeldt–Jakob disease. (a) Foci of status spongiosus are present in the neocortex of the temporal lobe. (b) Prion protein is deposited in these foci, (a) H&E 160×. (b) Immunohistochemistry for prion protein 200×. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions

Fig. 23 Subcortical (arteriosclerotic) leukoencephalopathy (Binswanger). The small arteries in the white matter have markedly thickened, fibrotic walls. H&E 120×. Forensic Science International 2004 146, 125-147DOI: (10.1016/j.forsciint.2004.06.025) Copyright © 2004 Elsevier Ireland Ltd Terms and Conditions