Category: Clinical Science
At the end of the session, participants will be able to:
- Recognize obvious and subtle gross changes of decomposition
- Recognize key microscopic features of decomposition
- Identify key implications of some forms of decomposition
COI Disclosure:
I do not have a relationship with a for-profit and/or a not-for-profit organization to disclose.
Presenter
Dr. Joseph was graduated from Harvard Medical School in 1991, was a resident in neuropathology at the Brigham and Women’s Hospital in Boston, and has been a practicing neuropathologist since 1995, at both the Beth Israel Deaconess Hospital in Boston and Alberta Precision Laboratories in Calgary, Alberta.
Jeffrey T. Joseph1 and Akmal Coetzee-Khan2
1Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
2Office of Chief Medical Examiner, Calgary, AB, Canada
Target Audience:
Residents
Other – Write In (Required): neurologists
CanMEDS:
Collaborator
Health Advocate
Scholar
Neuropathology of decomposition
Abstract
Although Swiss cheese “artifacts” are well-recognized in neuropathology, other aspects of brain decomposition are rarely discussed. Some of these changes can be confused with other pathological changes and can have implications beyond the simple post-mortem presence of bacteria. Gross and microscopic case reviews from autopsies involving different degrees and forms of decomposition were performed. Early or subtle forms of decomposition are often grossly visible as a loss of fine anatomic details (e.g., loss of pencillary fibres in the putamen). Microscopically, involved regions display widespread tissue acidophilia of all cellular elements. Tissue becomes pale and homogeneous in appearance. Decomposition changes typically develop in regions of the brain that are furthest from formalin fixation. In conclusion, decomposition is more advanced in areas of brain furthest from formalin penetration, is more advanced when formalin is limited, and is more advanced when formalin penetration and diffusion is restricted. Early decomposition often grossly effaces fine anatomic features in deep brain regions. Microscopic decomposition is often associated with widespread and indiscriminate cellular acidophilia that is associated with the lactic acidosis of anaerobic metabolism. Histologic changes can resemble early ischemia. Decomposition implies the brain was seeded with offending bacteria prior to death.