Instantaneous rigor, historically referred to as cadaveric spasm, remains a controversial concept in forensic pathology with divergent interpretations. Despite skepticism regarding its status as a distinct entity, apparent immediate postmortem fixation-particularly of the hands-continues to be reported. We describe a witnessed suicidal railway fatality in a 38-year-old female who exhibited unusual limb postures suggestive of instantaneous rigor. Detailed scene reconstruction and autopsy revealed heterogeneous limb positioning: some postures were attributable to biomechanical support, whereas others, particularly involving the hands, were not readily explained by environmental factors, object retention, or conventional postmortem changes. These findings may be better interpreted as reflecting terminal neuromuscular activity during a brief agonal phase, followed by stabilization of the resulting posture by early rigor mortis. A comparable suicidal hanging case demonstrated similar hand postures, providing additional observational support for this proposed interpretation. Overall, these observations are consistent with a hypothesis that apparent instantaneous fixation may represent a continuum of terminal neuromuscular phenomena rather than a distinct postmortem entity. Careful correlation of scene findings with autopsy features remains essential when interpreting such unusual postmortem postures. Although these observations are hypothesis-generating, they highlight the importance of distinguishing terminal agonal neuromuscular activity from postures traditionally attributed to cadaveric spasm during medico-legal interpretation.

Bone bruises or occult bone lesions, are well-documented in sports medicine and trauma surgery but were so far not in the focus of forensic diagnostic methods and received only marginal attention in forensic practise. This is surprising as these microtrabecular fractures caused by compressive forces, can provide crucial forensic evidence, particularly in cases where external injuries are minimal or absent. Despite their potential significance in trauma reconstruction, forensic reports of bone bruises remain limited. We investigated five cases with evidence of bone contusions under different circumstances. An unidentified mummified and putrefied male found in an abandoned area (case 1); a young male homicide victim with fatal craniocerebral trauma (case 2); a young male who sustained a fatal head injury in a head-on motorcycle collision with a highway pole (case 3); a male railway accident victim with multiple injuries (case 4) and a young male, side passenger in a hatchback, involved in a fatal head-on collision with a loaded truck on a busy highway (case 5). While bone bruises were identified on the skull in cases 1, 2 and 3, well-marked femoral bruises were detected in cases 4 and 5. The bruises showed dark focal discolorations of the bone surface with associated linear fissures or fractures at autopsy. This case series demonstrates the forensic utility of bone bruises and their great potential in reconstruction of trauma events and direction of impact sites with greater accuracy. Further studies using standardized protocols and including additional techniques such as diaphanoscopy, micro-CT or histopathology are needed to better understand the reconstructive significance of bone bruising in the forensic investigation of trauma.

Aneurysmal subarachnoid hemorrhage (aSAH) is a debilitating condition with significant morbidity and mortality rates. Despite advancements in treatment, understanding the underlying pathophysiology, particularly the inflammatory response, remains crucial for improving patient outcomes. In this study, we investigated the presence of transmembrane protein 119 (TMEM119) of microglial cells in cerebrospinal fluid (CSF) as a potential marker for neuroinflammation following aSAH. CSF samples were collected from aSAH patients, pathological and healthy controls, processed, and analyzed using immunocytochemistry. TMEM119-positive microglial cells were consistently identified in the CSF of aSAH patients, exhibiting amoeboid morphology and intense staining. Importantly, microglial cells were detected as early as the first day post-bleeding, persisting throughout the acute phase in some cases. Analysis of consecutive samples revealed varying trends in microglial cell numbers, with a peak during the initial phase followed by a gradual decline. Our findings suggest that microglia may migrate into the CSF following aSAH, potentially serving as an early predictor of inflammatory-related CNS damage. This study underscores the importance of understanding neuroinflammatory processes in aSAH and opens avenues for further research on the role of microglia in CNS disorders by liquid biopsy.

There are only few reports on the neuropathologic findings of fire victims. We investigated brain tissues of a 44-year-old and a 77-year-old man for neuropathologic examination with dehydration, embedding in celloidin, sectioning at 400 μm, and staining with gallocyanin. Microscopically, neurons were less well stained than those from an 87-year-old woman who died of cancer and whose brain had been fixed in formalin for three months. Glial cells were optimally stained. We observed local, laminar and disease-related qualitative and quantitative differences in the amygdaloid complex, temporal allo- and isocortex together with hyperchromatic staining of the medullary layer in the temporal lobe of both fire cases. The vasculature was well preserved and free of blood cells or clotted blood. The heat in fire deaths apparently acts as a kind of fixation, similar to the intention of formalin use, without the confounding effects of agonal and postmortem factors. Heat is most likely a major factor in microwave fixation. Thick gallocyanin-stained sections allow intuitive visual diagnosis of local and laminar neuronal degeneration or gliosis and have the potential to enhance and refine neuropathology-related diagnoses.

On the skull, the best known and most frequently observed autopsy findings are the heat fractures of the skull and the burn hematoma. The macromorphological changes of the brain have been described comparatively less frequently in the primary and secondary literature. We have evaluated the fire deaths of our institute over a period of 10 years with regard to the macromorphological changes of the skull and brain and described four stages (0-III) after postmortem fireexposure. In stage 0, the scalp showed up to third-degree burns, but the skull and brain were not affected. In stage I, in which the scalp showed fourth degree burns but the skull was still completely intact and unbroken, a certain hardening of the brain and a paling of the lateral parts of the temporal lobes, in particular, could already be regularly observed. In stage II, the head skin was burned away, and the skull was charred but still closed. There was a noticeable shrinkage of the dura mater, which was often torn. The brain itself appeared shrunken, pale and showed a flattening of the convolutions and a spreading of the furrows. In stage III, the skull was opened, charred to calcified and broken in clods. Tears in the dura mater led to herniation of brain tissue to the outside. The aim of this study was to classify the macromorphological changes of the skull and brain after fire exposure, both chronologically and according to their severity. The proposed staged classification (0-III) is intended to summarize the findings and to update and complement the descriptions in the older literature. It can be seen as an extension and further development of the Crow-Glassman scale, which classifies the extent of fire destruction of human bodies.

Geometric morphometrics is a very useful but rarely applied concept in forensic anthropology. It uses information on the shape of an object for data analysis. For this study, geometric morphometrics has been used to compare the shape of the frontal bone between a German and a Euro-American sample (both early 20th century). Results were compared using size-only, shape-only and size-and-shape combined. Results show that the frontal shapes of the two study populations can clearly be distinguished from one another. The best classification results could be achieved when combining size and shape data for analysis. Centroid size showed significant variation by group and sex, and that Euro-Americans are more sex dimorphic than Germans. We conclude that shape data provides a considerable amount of extra information for population affinity estimation, even on a single cranial bone like the frontal. A broader application of geometric morphometrics in forensic anthropology could thus help generating a more reliable biological profile, as well as providing additional insight into German-American morphometric differentiation.

Abstract Plexus injury results in lifelong suffering from flaccid paralysis, sensory loss, and intractable pain. For this clinical problem, regenerative medicine concepts set high expectations. However, it is completely unknown how dorsal root ganglia (DRG) are affected by accidental deafferentation. Here, we investigated human DRG in a clinically characterized cohort of patients with plexus injury. Avulsed DRG from 13 patients were collected during reconstructive nerve surgery. DRG were analyzed using large-scale microscopy, deep learning-based bioimage analysis, and RNA fragment sequencing of histopathological slices. In about half of the patients, we found a complete loss of DRG units consisting of neurons, satellite glial cells (SGC), and macrophages. The DRG cells were replaced by mesodermal/connective tissue. In the other half of the patients, the cellular units were well preserved and we found no gliosis and no significant neuronal loss. Furthermore, the expression of subtype-specific sensory neuron marker genes was preserved. However, downregulation of neuronal attributes associated with ion transport, synapses, and neuronal projection indicated a dormant neuronal phenotype. Injured DRG showed signs of ongoing inflammation and connective tissue remodeling. Patients with ‘neuronal preservation’ had less pain than patients with ‘neuronal loss’. Arm function improved after the nerve reconstruction, but the pain phenotype did not. With this study, we call for early intervention after injury to protect the DRG from complete cell loss. Pain patients may benefit from anti-inflammatory therapy. Future regenerative medicine concepts will need at least two translational directions: reafferentation of existing DRG units or replacement of the entire DRG.

Background: E-scooters have been part of road traffic in Germany for over 4.5 years and have since then become more important in police traffic control. The present study aims to give a first description of e-scooter cases in the catchment area of the Institute of Forensic Medicine in W & uuml;rzburg. Material and methods: All driving ability reports on e-scooter riders (n = 84) between June 2019 and January 2024 were retrospectively evaluated. Performance deficits, driving errors, circumstances and the substances detected in blood were analyzed. Results: Almost all e-scooter riders in our study population were men aged between 20-30 years. Most riders were under the influence of cannabis, amphetamines or alcohol. The main reason for traffic control was missing or expired insurance license plates. The times of offenses had a tendency towards the evening through night and towards warmer seasons of the year. The offenders showed less performance impairment during the medical examination performed later than during the police examination. Discussion: Compared to previous e-scooter studies, this work also examined the influence of drugs on e-scooter riders. The retrospective data analysis revealed similar trends, e.g., in terms of age, gender and seasonal distribution but also some differences. The results show the need of further studies examining the influence of drugs on e-scooter riding.

BACKGROUND:Plexus injury results in lifelong suffering from flaccid paralysis, sensory loss, and intractable pain. For this clinical problem, regenerative medicine concepts set high expectations. However, it is largely unknown how dorsal root ganglia (DRG) are affected by accidental deafferentation. METHODS:Here, we phenotyped DRG of a clinically and MRI-characterised cohort of 13 patients with plexus injury. Avulsed DRG were collected during reconstructive nerve surgery. For control, we used DRG from forensic autopsy. The cellular composition of the DRG was analysed in histopathological slices with multicolour high-resolution immunohistochemistry, tile microscopy, and deep-learning-based bioimage analysis. We then sequenced the bulk RNA of corresponding DRG slices. RESULTS:In about half of the patients we found loss of the typical DRG units consisting of neurones and satellite glial cells. The DRG cells were replaced by mesodermal/connective tissue. In the remaining patients, the cellular units were well preserved. Preoperative plexus MRI neurography was not able to distinguish the two types. Patients with 'neuronal preservation' had less maximum pain than patients with 'neuronal loss'. Arm function improved after nerve reconstruction, but severe pain persisted. Transcriptome analysis of preserved DRGs revealed expression of subtype-specific sensory neurone marker genes, but downregulation of neuronal attributes. Furthermore, they showed signs of ongoing inflammation and connective tissue remodelling. CONCLUSIONS:Patients with plexus injury separate into two groups with either neuronal preservation or neuronal loss. The former could benefit from anti-inflammatory therapy. For the latter, studies should explore mechanisms of neuronal loss especially for regenerative approaches. CLINICAL TRIAL REGISTRATION:DRKS00017266.

Traumatic brain injury (TBI) is a ubiquitous, common sequela of accidents with an annual prevalence of several million cases worldwide. In forensic pathology, structural proteins of the cellular compartments of the CNS in serum and cerebrospinal fluid (CSF) have been predominantly used so far as markers of an acute trauma reaction for the biochemical assessment of neuropathological changes after TBI. The analysis of endogenous metabolites offers an innovative approach that has not yet been considered widely in the assessment of causes and circumstances of death, for example after TBI. The present study, therefore, addresses the question whether the detection of metabolites by liquid-chromatography-mass spectrometry (LC/MS) analysis in post mortem CSF is suitable to identify TBI and to distinguish it from acute cardiovascular control fatalities (CVF). Metabolite analysis of 60 CSF samples collected during autopsies was performed using high resolution (HR)-LC/MS. Subsequent statistical and graphical evaluation as well as the calculation of a TBI/CVF quotient yielded promising results: numerous metabolites were identified that showed significant concentration differences in the post mortem CSF for lethal acute TBI (survival times up to 90 min) compared to CVF. For the first time, this forensic study provides an evaluation of a new generation of biomarkers for diagnosing TBI in the differentiation to other causes of death, here CVF, as surrogate markers for the post mortem assessment of complex neuropathological processes in the CNS (“neuroforensomics”).

E‑Scooter sind seit über 4,5 Jahren Teil des Straßenverkehrs in Deutschland und haben seitdem in der polizeilichen Verkehrskontrolle zunehmend an Bedeutung gewonnen [16]. Das Ziel der vorliegenden Arbeit war es, eine Erstbeschreibung über die im Institut für Rechtsmedizin der Universität Würzburg bearbeiteten Fälle anzufertigen. Alle Fahrsicherheitsgutachten über E‑Scooter-Fahrer (n = 84) am Institut für Rechtsmedizin Würzburg aus dem Zeitraum Juni 2019 bis Januar 2024 wurden retrospektiv ausgewertet. Hierbei wurden u. a. Ausfallerscheinungen, Fahrfehler, Tatumstände und die im Blut nachgewiesenen Substanzen analysiert. Fast alle E‑Scooter-Fahrer in unserem Kollektiv waren Männer, viele im jüngeren Alter. Die häufigsten nachgewiesenen Substanzen im Blut waren Cannabinoide, Amphetamine und Alkohol, der häufigste Grund einer Verkehrskontrolle ein fehlendes bzw. abgelaufenes Versicherungskennzeichen. Die Vorfallszeitpunkte lagen eher abends bis nachts und zu wärmeren Jahreszeiten. Die Beschuldigten waren bei der späteren ärztlichen Untersuchung weniger leistungsreduziert als bei der polizeilichen. Im Vergleich zu früheren E‑Scooter-Studien untersuchte diese Arbeit auch den Einfluss von Drogen auf die Fahrsicherheit. Die retrospektive Datenanalyse ergab z. T. ähnliche Tendenzen z. B. bezüglich Alter, Geschlecht und jahreszeitlicher Verteilung, z. T auch Unterschiede. Weitere Studien zum Einfluss von Drogen auf E‑Scooter-Fahren erscheinen vor diesem Hintergrund unabdinglich.

In Europe, 350,000 people die suddenly and unexpectedly every year. The majority of sudden deaths are caused by cardiac alterations and known as sudden cardiac death (SCD). The interpretation of medicolegal findings is especially difficult in those SCDs where there is no morphological correlate and no antemortem electrocardiograms or relevant medical history are available. The Wolff-Parkinson-White (WPW) syndrome, in which an accessory electrical conduction pathway exists between the atrium and the ventricle in addition to the physiological conduction system, is mostly a benign disease of the heart, which may lead to cardiac arrhythmia. A 16-year-old boy with a known history of WPW syndrome since the second year of life had consumed alcohol before death and was found sitting on the toilet fully dressed. The autopsy performed on the deceased 3 days postmortem showed a marked mass increase of the heart with left ventricular concentric hypertrophy and macroscopic signs of cardiomyopathy. In the microscopic examination, the right and left ventricles and the atria were found to have a regular structure with normal vessels. Hematoxylin-eosin (HE) and elastica-van-Gieson (EvG) staining disclosed a thin accessory muscle bridge connecting the left atrium with the left ventricle as a possible morphological correlate of a fatal cardiac arrhythmia.

Michael Bohnert führt in diesem Buch leicht verständlich in die Rechtsmedizin ein. Er erklärt die verschiedenen Untersuchungsmethoden sowie Wissenswertes zur Thanatologie und medizinischen Kriminalistik. Ausführlich beschreibt er die unterschiedlichen Verletzungsarten und ihre Merkmale. Ein Kapitel zu den forensischen Wissenschaften rundet diese Einführung ab. Auch für Nichtmediziner geeignet!

Sepsis is one of the major threats for the survival and prognosis of patients in intensive care units. In cases where detailed clinical data and monitoring is available, the diagnosis of sepsis is reliable. But when clinical data are incomplete or missing and sepsis is only suspected based on the autopsy results, the picture is often equivocal. This report describes the gross pathological findings obtained from the autopsy of a 48-year-old woman with Crohn's disease after surgical intervention. Macroscopically, we found intestinal perforation and signs of peritonitis. Histologically, the pulmonary/bronchial arteries were lined with E-selectin (CD 62E)-positive endothelial cells, which are an established postmortem histological marker of sepsis. We extended our investigations to the cerebral cortex and subcortical medullary layer. The endothelium of the cortical vessels and those in the cerebral medullary layer were likewise immunopositive for E-selectin. Furthermore, numerous TMEM119-positive, highly ramified microglial cell profiles were found in the grey and white matter. Microglial cells were lining the vascular profiles. In addition, TMEM119-positive microglial profiles were abundant in the cerebrospinal fluid (CSF). Multiorgan E-selectin positivity of the vascular endothelia provides further evidence for the postmortem diagnosis of sepsis.

Objective Plexus injury results in lifelong suffering of flaccid paralysis, sensory loss, and intractable pain. For this clinical problem, regenerative medicine concepts, such as cell replacement for restoring dorsal root ganglion (DRG) function, set high expectations. However, it is completely unclear which DRG cell types are affected by plexus injury. Methods We investigated the cellular composition of human DRG in a clinically characterized cohort of patients with plexus injury. Avulsed DRG of 13 patients were collected during reconstructive nerve surgery. Then, we analyzed the cellular composition of the DRG with a human-adapted objective deep learning-based analysis of large-scale microscopy images. Results Surprisingly, in about half of the patients, the injury-affected DRG no longer contained DRG cells. The complete entity of neurons, satellite glial cells, and microglia was lost and replaced by mesodermal/connective tissue. In the other half of patients, the cellular entity of the DRG was well preserved. We found no loss of neurons, no gliosis, and macrophages close to single sensory neuron/satellite glial cell entities. Patients with ‘neuronal preservation’ had less pain than patients with ‘neuronal loss’. Interpretation The findings classify plexus injury patients in two categories: type I (neuronal preservation) and type II (neuronal loss). We call for early, post-accidental interventions to protect the entire DRG and improved MRI diagnostics to detect ‘neuronal loss’. Regenerative medicine to restore DRG function will need at least two translational directions: reafferentation of existing DRG units for type I injuries; or replacement of the entire DRG structure for type II patients.

Thermal trauma to deceased remains is defined as the effects of heat on a body. In most cases the heat is the result of a fire. The external as well as the internal findings in burned bodies depend on the effective temperature applied to the body, the time for which it is applied, the kind of transmission of the heat to the body, and other prevailing conditions. The consequences are burns of the exposed tissue, changes in the content and distribution of tissue fluid, fixation of the tissue, and shrinking processes. Many findings seen at autopsy may be of postmortem origin with fluent transitions between intravital, perimortal and postmortem changes. Therefore, the determination of the vitality of the findings is of crucial importance.