ABSTRACT
The prevalence of natural disease processes in the nervous system of those adult individuals coming to autopsy in a general hospital or a forensic setting is very high, and it is almost a rare case in which the brain is truly without pathological diagnosis. Most individuals past middle age will commonly show one or more of the following: manifestation of atherosclerosis in their cerebral vessels, buildup of lipofuscin pigment in many of the neurons, a few lacunar infarcts in the basal ganglia, accumulation of corpora amylacea in the subpial regions, mineralization of their choroid plexuses and pineal body, and quite probably the odd neurofibrillary tangle or senile plaque in the cerebral cortex. Incidentally, small unruptured “berry” aneurysms, cryptic vascular anomalies, small asymptomatic meningiomas, or unrecognized acoustic Schwannomas may be discovered. Generally, such findings are not unexpected and would ordinarily have little impact on the interpretation of the neuropathology in a forensic setting; however, in occasional cases recognition and proper interpretation of naturally occurring disease processes in the brain will have significant impact on the forensic investigation. These cases fall into two groups: those in which there is a sudden or unexpected death in which systemic pathology is lacking and it is hoped the cause (and manner) of death will be revealed by an intracranial examination, and those in which the presence of intracranial pathology may have influenced events prior to the victim’s death or combined with external events to cause the death. So that an informed analysis of such cases can be made, a brief review of the general neuropathology of those processes and disease conditions that can be of importance to the forensic pathologist is undertaken to provide background and a context within which elements of a given case may be interpreted.
