“These are the findings of a post mortem examination carried out at 10 A.M on Tuesday, the 10th October, 2006 on the body of Professor Trofim Gorshkov. Professor Gorshkov is reported to have collapsed suddenly after an epileptic fit on the evening of Friday, the 6th of this month.
Summary of Clinical History
Professor Gorshkov was a fifty five year old ex-smoker with a past history of type 2 diabetes and hypertension, for which he was taking gliclazide, amlodipine and simvastatin. On the evening of his death, he was witnessed to demonstrate a sudden change in mood, exhibiting marked euphoria. Within a few seconds, he collapsed and entered a brief tonic-clonic phase, before experiencing cardiac arrest. Cardiopulmonary resuscitation was attempted by onlookers, but he was pronounced dead upon arrival to hospital.
There was no reported trauma, or ingestion of illicit substances, though the deceased had consumed a moderate amount of alcohol, estimated to be between eight and twelve standard units in the course of the evening.
1 Formal navy suit jacket, with staining upon the lapel
2 White dress shirt
3 Navy trousers
4 Brown leather belt
5 Blue, cotton boxer shorts
6 Navy socks
7 Black, size 9 leather shoes.
8 Plain, gold wedding ring upon left 4th finger
9 Digital wristwatch on left wrist
Body is that of a male, with short grey hair and beard. Length is 182 cm, weight is 84kg. There are electrode pads attached to the front of the chest and to each wrist and shin. There is a scar in the right lower abdomen, compatible with previous appendicectomy. There are no tattoos, piercings or other scars or distinguishing features. Appearance is compatible with age.
There are a few abrasions on the left arm and left side of back, compatible with minor injuries from a collapse. There are no significant external injuries. Examination of the hands reveals no clubbing, Dupuytren’s contracture, or palmar erythema.
The body is not jaundiced, or oedematous.
There is post mortem lividity on the back, but no rigor mortis.
The arrangement of the organs appears normal, with no dextrocardia or malformation of the great vessels. There is a normal distribution of adipose tissue for a man of this build and age. There is no intra-abdominal free fluid or adhesions. There are no enlarged lymph nodes in the abdomen or thorax.
There is no pericardial effusion. The heart is of normal size and shape, and weighs 315g. There is no significant ventricular hypertrophy and multiple sections show no evidence of infarction. There is a mild degree of mitral incompetence, but no other significant valvular disease. The coronary arteries show a moderate degree of atherosclerosis, with a maximum 40% stenosis noted in the right coronary artery. There was no significant coronary artery occlusion.
The great vessels are normally arranged. The aorta is of normal calibre with no aneurysm or rupture evident. There is mild to moderate atheroma throughout the length of the aorta, and the large branches are patent. The pulmonary vessels are widely patent with no evidence of thromboemboli.
There are no tumours or obstructions in the larynx or trachea.
The pleura are unremarkable, with no pleural effusions or adhesions.
The right lung weighs 590 grams, and the left 540 grams. The pleural lung surfaces are dull and when cut, there is loss of parenchyma and numerous areas of alveolar loss and small bullae. There is no anthracosis. The large bronchi contain a small amount of mucus.
The oesophagus is normal with no evidence of ulceration or varices. There is a small hiatus hernia noted, but no associated oesophagitis or stricture. The stomach contains food and liquid, with no evidence of tablets or capsules. The mucosa appears normal, with only some mild antral gastritis, but no ulceration or malignancy.
The small intestine appears unremarkable, with no evidence of tumour, obstruction or perforation.
The large bowel contains a moderate amount of formed stool, with no evidence of tumour or perforation. The appendix is absent. There are several diverticulae in the descending colon.
The liver is enlarged and weighs 3420 grams. The cut surface is greasy and pale yellow in colour, indicating steatosis. There is no evidence of progression to hepatitis or cirrhosis.
The gallbladder and biliary tree are normal. The gallbladder contains 10 mls of green bile, but no stones.
The spleen appears normal and weighs 170 grams.
The pancreas appears normal and weighs 98 grams.
The right kidney weighs 183 grams and the left kidney weighs 160 grams. Each kidney shows normal morphology with no hydronephrosis and a normal calyceal system. The renal pelvices and ureters are unremarkable.
The adrenal glands appear normal and each weighs 5 grams.
The bladder is normal.
The prostate is smoothly enlarged, inkeeping with the deceased’s age. The prostate weighs 35 grams. There are no macroscopically visible areas of malignancy.
The left testis weighs 22 grams and the right weighs 18 grams. There are no obvious focal lesions. The penis is uncircumcised.
Head and Neck
The thyroid is normal and weighs 38 grams. There is no cervical lymph node enlargement.
The scalp and skull are unremarkable, with no evidence of trauma. The dura and meninges are normal. The brain and brainstem are markedly oedematous and weighs 1650 grams. There is flattening of the gyri and narrowing of the sulci. There is coning of the cerebellar tonsils.
The ventricles are compressed and the cerebrospinal fluid is clear. Sections through the hemispheres show no mass lesions, infarction or haemorrhage. There is normal pigmentation of the substantia nigra. Sections through the brainstem demonstrate multiple areas of haemorrhage ranging from 1 to 5 millimetres throughout the thalamus and hypothalamus, with some extension into the midbrain and pineal gland. The pons, medulla and cerebellum are largely unaffected, but there is damage to the cerebellum where the inferior aspect has herniated through the foramen magnum.
Microscopic Examination and Toxicology
(During an autopsy, samples are taken from each organ for histological analysis, and samples of stomach contents and vitreous humour (the fluid within the eye) are sent for toxicology. I have omitted the histology and toxicology sections, as they hold little interest for the non-medical man, and do not add any new information, save to confirm that the Professor had consumed a moderate amount of alcohol prior to his death. There were no other toxic or illicit substances detected.)
Summary of findings
This 55 year old man died from multiple haemorrhages within the thalamus and hypothalamus, leading to a rapid elevation of intracranial pressure and resulting in tonsillar herniation through the foramen magnum. There is no history or evidence of trauma, therefore the cause of death is recorded as
1a – Cerebral haemorrhage due to
1b – cerebrovascular disease due to
1c – hypertension
contributed to, but not caused by
2 – diabetes mellitus, emphysema and alcoholic liver disease.”