Abstract
A neuropathological study of 41 forensic autopsy cases of hypoxic/ischemic brain damage has been undertaken, using immunohistochemical staining to detect the 70-kDa heat shock protein (hsp70) and the status of the glial cells. In cases surviving 2–5 h after hypoxic/ischemic injury, ischemic cell changes were seen whereas glial reactions were not apparent. In cases of longer survival, neuronal necrosis and a loss of neurons were seen, and these changes were accompanied by proliferation of glial fibrillary acidic protein (GFAP), vimentin-positive astrocytes and microglia which transformed into rod cells or lipid-laden macrophages. In cases with a history of hypoxic attacks, GFAP-positive and vimentin-negative astrocytes had proliferated in the CA3 and CA4 regions of hippocampus. The cases of severe hypoxic injury, such as an asthmatic attack and choking, showed no ischemic changes in the hippocampul neurons. On the other hand, the CA1 pyramidal cells showed neuronal necrosis in a patient suffering from tetralogy of Fallot (TOF), who survived for 2 h after a traffic accident. Therefore, it is suggested that even moderate hypoxic injury induces astrocytosis in the CA3 and CA4 regions and may affect the neuronal proteins and the metabolism, and that in cases with a history of hypoxic attacks neuronal damage may be severe even several hours after ischemic injury. The protein hsp70 expression was found in the CA2, CA3 and CA4 regions in cases of long-term survival after severe hypoxic/ischemic injury and in cases of alcoholic intake or toluene abuse just before acute death. Thus, it is suggested that the detection of hsp70 in the hippocampus indicates hypoxic/ischemic injury or other stress prior to death. In forensic practice, immunohistochemical investigation of the hsp70 and glial cell staining can be of great value for diagnosing not only hypoxic/ischemic brain damage during the process of death but also the victim's past history of hypoxic attacks.
Zusammenfassung
Eine neuropathologische Studie von 41 forensischen Autopsie-Fällen mit hypoxischen/ischämischen Hirnschäden wurde durchgeführt, um das 70-kDA Hitzeschock-Protein (hsp70) und den Zustand der Gliazellen zu untersuchen. In Fällen, in denen der hypoxisch-ischämische Schaden 2–5 Stunden überlebt wurde, waren ischämische Schäden erkennbar, während Glia-Reaktionen noch nicht vorhanden waren. In Fällen längerer Überlebenszeit war ein neuronale Nekrose und ein Verlust von Neuronen zu beobachten, und diese Veränderungen waren begleitet von einer Proliferation des glialen fibrillären sauren Proteins (GFAP), der Vimentin-positiven Astrozyten und der Mikro-Glia, welche in stabförmige Zellen oder lipidbeladene Makrophagen transformierte. In Fällen mit einer Anamnese von hypoxischen Attacken war eine Proliferation GFAP-positiver und Vimentin-negativer Astrozyten in der CA3- und CA4-Region des Hippocampus zu beobachten. Die Fälle mit schwerem hypoxschämischen Schaden, wie Asthma-Anfall und Strangulation, zeighten keine ischämischen Veränderungen in den Neuronen des Hippocampus. Andererseits zeigten die CA 1-Pyramiden-Zellen bei einem Patienten mit Fallot'scher Tetralogie (TOF), welcher zwei Stunden nach einem Verkehrsunfall starb, eine neuronale Nekrose. Daher wird vermutet, daß auch weniger schwere hypoxische Schäden eine Astrozytose in der CA3- und CA4-Region induzieren und einen Einfluß haben dürften auf die neuronalen Proteine und auf den Metabolismus und daß in Fällen mit einer Anamnese hypoxischer Attacken der neuronale Schaden schwer sein kann, sogar mehrere Stunden nach dem ischämischen Schaden. Das Protein hsp70 wurde in den CA2-, CA3- und CA4-Regionen in Fällen langzeitigen Überlebens nach schweren hypoxischen/ischämischen Schäden gefunden und in Fällen, in denen kurz vor dem Tode eine Alkoholaufnahme oder Toluol-Mißbrauch stattfand. Daher wird vermutet, daß ein Nachweis hsp70 im Hypocampus eine hypoxischen Schaden oder einen anderen Streß kurz vor dem Tode an zeigt. In der forensischen Praxis sind die immunhisto chemische Untersuchung von hsp70 und Gliazell-Fär bungen von großer Bedeutung für die Diagnostik nicht nur des hypoxisch-ischämischen Hirnschadens während des Sterbeprozesses, sondern auch für die Diagnostik der Anamnese des Opfers im Hinblick auf hypoxische At tacken.
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Kitamura, O. Immunohistochemical investigation of hypoxiclischemic brain damage in forensic autopsy cases. Int J Leg Med 107, 69–76 (1994). https://doi.org/10.1007/BF01225492
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DOI: https://doi.org/10.1007/BF01225492