A 17-YEAR-OLD girl had a 7-year history of neurologic decline that appeared to be related to a familial degenerative neurologic disorder. She developed chronic malnutrition, decubitus ulcers, marasmus, and repeated episodes of aspiration pneumonia. Her status was placed on do not resuscitate, and she died with a clinical picture of acute respiratory distress syndrome.
The extent of the autopsy was restricted by the family to removal and examination of the brain and spinal cord. The permit also restricted making incisions into the back or torso. The findings of an extensive neuropathologic workup of the brain were most compatible with a familial olivopontocerebellar atrophy.Based on these findings, a cause of death statement could be prepared as follows:
Although the spinal cord may be removed during an autopsy through the foramen magnum using a special tool, the removal may be difficult without causing considerable artifactual damage. Removal of
Hanzlick R. Case of the Month. Arch Intern Med. 1997;157(22):2557. doi:10.1001/archinte.1997.00440430033004