The tightness of the dura should be assessed when it is being incised since this is the only time that this can be done. The orbital contents are considered separately in chapter 3. A mid-line incision is made in the skin covering the occipital bone and the upper cervical region, and the skin reflected. Since both muscles pass medially in the orbit the top, the lateral and medial sides of the eye can now easily be identified, and the eye correctly orientated and located. Any residual attachments to the lids should now be freed. They can be dis- sected out of the transverse processes of the cervical vertebrae at the time of autopsy but it is often preferable to remove the cervical vertebrae and the bone adjacent to the foramen magnum in one block. How a brain should be dissected is also illustrated, and there is a final chapter on brain neuro-anatomy.
Focuses on hospital autopsy, while also providing a brief introduction to forensic autopsy. Sections are taken 3 to 4 mm from the surface of the block, i. Library of Congress subject headings for this publication: Nervous system -- Diseases -- Atlases. The Extracranial Cerebral Arteries in the Neck No post mortem examination on a patient who has died as a result of a stroke, or who has a history of a previous stroke, is complete unless the major extracranial cerebral arteries, viz. Dissection of the Fixed Brain; 8. If the cut in the temporal muscle is made lower than suggested, the saw will go through the petrous part of the temporal bone leaving a sharp bony spur on the skull cap which will inevitably damage the brain when the skull cap is being removed. By far the best method is to dissect out the principal arteries and then to examine them after preliminary fixation.
In these circumstances it is helpful to insert a malleable spatula Fig. We have already expressed our appreciation of the invaluable help given to us by Professor W. These are followed by a series of coronal slices of the cerebral hemispheres. Carotid sinuses There are occasions on which the vertebral arteries require to be examined in detail. The text is well illustrated and is organised system by system. An artificial eye can be inserted to provide the best cosmetic result see Figs. Body of lateral ventricle 23.
The pathologist will more often than not be aware of abnormalities in the brain in the course of obtaining the conventional slices, and he may decide that it would be advantageous to obtain some thinner slices if he suspects that a lesion, e. Provided slices of uniform thickness have been cut as described on p. Dissection of the Fixed Brain The type of dissection depends to a certain extent on the site of any abnormality suspected of being present. Its aim is simply to illustrate the principal anatomical structures in the brain, using photographs rather than diagrams, that should be recognised by a competent pathologist, if only to allow him to state reasonably precisely the site of any lesion identified post mortem. This is simply a matter of preference but it is important to be consistent so that there is never any problem in differentiating the left from the right hemisphere, either when demonstrating the brain or when examining photographs of the specimen.
The former causes rapid opacification of the lens and vitreous, and for the best photomacroscopic results washing and post-fixation in 70% alcohol are to be recommended. The cervical nerve roots should be followed from the spinal cord and the bone adjacent to the intervertebral foramina dissected away to expose the ganglia. Removal of the eye itself will be dealt with before a description of the exploration and removal of the orbital contents is provided. Insert a muscle hook into the orbit above the medial rectus muscle, pass the hook behind the muscle and pull the eye laterally. When it has been completely transected it 'gives 1. If, however, it is enlarged for any reason, either as a result of an intracranial expanding lesion or of diffuse brain swelling, the increased volume of the brain makes access to the various structures that have to be cut more difficult. Step serial sections may have to be cut from the larger block in case any abnormalities are restricted to its inferior portion.
The first cut should be made at the junction between the medial third and the lateral two-thirds of the hemisphere since this will cut through the dentate nucleus arrow in Fig. Splenium of corpus callosum 2. The Post Mortem Technique Handbook provides a comprehensive practical guide to performing the modern post mortem. Retract the eye- lids to see if there is any subconjunctival haemorrhage. The material is divided into two sections for ease of use: a manual covering specific autopsy procedures, biosafety, generation of autopsy reports, preparation of death certificates, and other essential subjects; and an atlas, organized by organ system, that captures the appearance of the complete spectrum of autopsy findings. Muscle and Nerve Widespread sampling of peripheral nerve and muscle is essential in any patient thought to have had some type of neuromuscular disease.
Any blood in the subdural space, unless it is an encapsulated chronic subdural haematoma, tends to flow out at this stage. Temporal horn of ventricle 135 8. The block requires to be of this thickness so that the lens and iris diaphragm are not disturbed. A final cut should be made in the mid-line through the vermis of the cerebellum. Inferior colliculus Tectum of mid-brain Aqueduct Tegmentum of mid-brain and pons Region of red nucleus Substantia nigra Cerebral peduncle Oculomotor nerve Superior cerebellar peduncle Superior medullary velum Basis pontis incorporating nuclei pontis and descending cortico-spinal tracts Pigmented nucleus of pons locus coeruleus Trigeminal nerve Fourth ventricle Middle cerebral peduncle Inferior cerebellar peduncle Region of hypoglossal and vagal nuclei Inferior olivary nucleus Pyramid Gracile nucleus Cuneate nucleus Decussation of pyramidal tracts.
The eyelids are partially closed and may be fixed by sutures inside the lids. Hume Adams and Margaret Murray have produced an atlas that illustrates basic post-mortem techniques in neuropathology. Author by : Michael T. After preliminary fixation, longitudinal and transverse blocks can then be easily obtained. A similar cut is then made on the other side and the brain stem detached from the cerebellum. Inferior surface lateral third 141. The cut should be continued rostrally to the base of the skull, care being taken in the cervical region not to allow the saw blade to plunge through the cervical nerve roots.