Forensic Pathology for Police - Brainshare Public Online Library

Central Nervous System 223
Neoplastic Heart Disease
Tumors of the heart are relatively rare, but do occasionally occur. Some of these may
be associated with sudden death, either via their mass effect (obstruction) within
the chambers of the heart or via induction of an arrhythmia. Some primary heart
tumors that have been described as causing sudden death include atrial myxomas
and papillary fibroelastomas of the valves. A very small benign neoplasm, called an
AV nodal tumor, “cystic tumor of the AV node” or “mesothelioma,” can result in
conduction system disturbances and sudden death (Disc Image 10.30).
Central Nervous System
The central nervous system (CNS) encompasses the brain (cerebrum, brainstem,
and cerebellum) as well as the spinal cord. There are numerous non-traumatic disorders
of the CNS that can be responsible for death, including many that can cause
sudden, unexpected death. The brain is obviously an important organ. Any disruption
of the brain, especially certain portions, can result in terrible disability or
death.
Congenital Anomalies
A variety of congenital anomalies can affect the CNS. Many of the lethal anomalies
are commonly accompanied by many other anomalies as part of a recognized
syndrome. Many of these are genetically based, for example “holoprosencephaly,”
in which the brain is not divided into two halves as normal. A severe brain abnormality
that is incompatible with life is “anencephaly,” in which a brain, or at least
a large portion of it, fails to develop. Some disorders may be compatible with life,
but can still cause significant disability, such as the “Arnold–Chiari malformation”
(abnormally small posterior aspect of skull, with crowding of the cerebellum and
brainstem), the “Dandy–Walker” abnormality (an enlarged posterior skull area, typically
associated with a cyst), and “spina bifida” (typically affecting the spinal cord,
with various degrees of complications, including paralysis).
Cerebral Palsy
Cerebral palsy (CP) is a general clinical description for a non-progressive neurologic
motor (muscular) disorder characterized by muscle spasticity, lack of tone, and discoordination.
It is generally believed to be due to insults suffered during intrauterine
(prenatal) development and/or during the perinatal (around birth) period. It may not
be readily apparent at birth, but becomes evident as a baby grows older. Persons with
CP may be totally normal from a mental/intellectual standpoint; however, some have