Autopsy questions

This is the way I see it too, Ames. jmo

 

nopey

A vagal response is neither theoretical nor controversial - it is a fact. I have seen it myself during carotid endarterectomy surgery, and believe me, it didn't take much to start it. True, there was an incision and the carotid and vagus nerve exposed but I feel sure it could also happen if the skin was intact. The congestion of the face occurs if the jugular is compressed. It may not have been compressed enough to cause congestion. I know some are convinced there was NO strangulation but I certainly think it was a factor. Imho.
Note: there was also petechiae on her lungs.

 

Great find, rashomon. I'll read it slowly and then I'll leave it to you and all those who understand it, or work in the medical field, like Texan for starters.

 

medical questions

But it looks like there were only few:

Again, it would be interesting to compare them to petechiae in the lungs of a conscious victim who had been struggling against an attacker
strangling her with a ligature.

How can the absence of cyanosis in JonBenet's face be explained?

Anthother medical question: the autopsy report mentions "semifluid" blood in the vagina. Does this mean the victim died before the blood could completely coagulate (?)
How long does it take for blood to coagulate?

TIA for your help, Texan.

 

I think if death occurs quickly, some of the signs won't be there. I have to go out right now, but I'll find the book I was reading about this when I get back.

 

OK Rash

Classical features of asphyxia

1. congestion of the face

Red appearance of the skin of the face and head. It is caused by the filling of the venous system when compression of the neck or some other obstruction prevents venous return to the heart


2. oedema of the face

Swelling of the tissues due to transudation of fluid from the veins caused by the increased venous pressure as a result of obstructions of venous to the heart.

3. cyanosis (blueness) of the skin of the face

Indicates the presence of deoxygenated blood in the congested venous system and possibly in the arterial system.

4. petechial haemorrhages in the skin of the face and eyes

tiny pinpoint haemorrhages, most commonly seen in the skin of the head and face, especially eyelids. They are also seen in the conjuntivae and sclera of the eyes. Due to leakage of blood from small venules as a result of increased pressure of the venous system. These are not diagnostic of asphyxia because they can appear instantaneously in the face and eyes following a violent episode of coughing or sneezing.

It was previously thought (incorrectly) that petechiae were an infallible hallmark of asphyxia.

Stages of death by asphyxiation

1. Increased efforts to breathe, facial congestion and onset of cyanosis.

2. Deepening congestion and cyanosis and appearance of petechiae.

3. Loss of consciousness, convulsions, vomiting and emptying of bladder.

4. Irreversible brain damage, dilation of pupils and death.

However, death from sudden cardiac arrest can occur at any stage of this progression.


Suffocation

Rapid deaths are reported when a plastic bag has been placed over a child's head either accidentally or deliberately. Typically, no 'classic signs' are seen and the face is usually pale when the bag is removed.

Smothering with a pillow or other object (including a hand) pressed over the nose and mouth will only very rarely cause any petechiae, any significant cyanosis or congestion unless the victim struggles and fights for breath.

Smothering may be virtaully impossible to diagnose if it is applied to those who cannot or do not resist - (elderly, infirm and young).


Pressure on the neck

i.e. manual strangulation, ligature strangulation and hanging. IN all of these, death may be relatively slow with the formation of the 'classic' asphyxial signs of cyanosis, congestion, oedema and petechiae or death may be rapid or even instantaneous due to sudden cardia arrest in which case a pale face with no cyanosis, congestion or petechiae may be observed.

__________________________________

The bottom line seems to be that congestion, cyanosis and petechiae occur significantly if death is prolonged or if the victim struggles. The sooner death occurs, the less likely they are to occur.

This sounds as though JonBenet died quickly or at least not primarily from slow strangulation. It doesn't support a theory that she fought and struggled against her killer.

 

Great info, Jayelles! Again, the Alert Scottish Viewer strikes!

So it seems, from what you have posted, that JonBenet died from strangulation without STRUGGLING against any attacker.

That is in line with the LACK OF DEFENSIVE INJURIES ON HER BODY.

So...again...THE HEAD BLOW CAME FIRST, DISABLING HER. Then the garrote was applied to strangle her at some point, whether quickly or within an hour or more?

We know the paintbrush was in all probability taken from the paint tote, used to inflict vaginal injury, then broken BY THE PAINT TOTE, and applied to the cord.

The cord was tied at the back of the neck, on the body as the hair tied into it and still attached to the scalp indicates. My experiment with the slip knot seen in the photos of the wrist binding still on the wrist did just as the autopsy photo shows of the garrote when still on the child's neck: the knot moved as I pulled. In the case of the garrote knot tied on the neck, it moved to the right side as it was pulled from behind. Does that indicate the person who pulled it was right-handed? Hm. Guess I need to do that experiment again and see which direction the knot moved when I pulled.

I believe the killer pulled the cord while straddling JonBenet's body, with her on her stomach, as well. I wonder if the bruises on the back of her shoulder came from holding her body down as the cord was pulled, to create the counterforce needed?

Here is where I can't imagine anything but the head blow coming independently of the strangulation: the head blow came from ABOVE the child. If she was on her stomach being strangled, then that blow would have been from behind her. Since the urine on the front of her long johns (and the alleged urine on the carpet outside the cellar door, if that's true) indicates she was on her stomach when she died, I think this is a good indicator that she was bludgeoned first, then immobile and not fighting when she was strangled to death lying on her stomach.

Dear god, what happened to that child in that house? Did it start with the blood on the pillowcase in her room? Was the prior molestation part of this event at first? Did it cause tensions that blew up that night? Or was she being molested that night, as well? And was the paintbrush used to cover up one or both?

 

Because I am a victim of a strangulation, that I obviously survived....this is the ONLY way that it could have happened. The blow imo...definately, without a doubt.. came first, knocking her unconscious. I know from experience that if the strangulation came first, she would have been clawing her neck to move the cord, so that she could breathe. If her hands had of been tied (as some IDI theories go) while she was being strangled...and before the head blow...there would have been rope burn on her wrists, where she fought to get free, to be able to reach up and try to remove the cord that was cutting off her air.

 

also

There are petechaie (however the heck you spell that darn word) above and below the the cord. Yes, they can occur for reasons other than strangulation but i know I have coughed and sneezed violently and never had any. I would think this may vary with different people. I don't think they would be on the neck from coughing or sneezing or convulsing.

Again, I am aware that there are those who don't believe the cord caused any strangulation at all. I am not one of them. She didn't die as a result of strangulation. But due to the petechaie above and below the cord, and on the lungs, I think there was some strangulation. I think it was a weak attempt to stage, that the head blow had already happened, she was unconscious, and that there was a vagal response.

 

With the recent accidental head injury and death of Natasha Richardson--such a tragedy it leaves me breathless--there are many doctors and neurologists on TV talking about head injuries.

In light of what they are saying, compared with the circumstances of Richardson's accident which left her functioning and feeling "well" for an hour or more afterwards, I doubt very seriously that JonBenet wasn't dropped on the spot when her skull was cracked in half, nearly.

Richardson's injury was a closed skull injury, after all. Her autopsy will shed more light on what transpired, but the medical experts have a similar "guess" that she had a contrecoup-type injury (my words), one of the brain smashing into the skull upon impact. They're speculating that this caused a blood vessel to break or leak in some way, eventually causing the pressure on the brain which can quickly become fatal, they say.

So thinking about the DEVASTATING skull injury, I imagine the brain injury was immediate with JonBenet. One thing that one doctor brought up when discussing brain injuries this week is that the brain, having nowhere to go when it swells, will begin to protrude from the hole at the base of the skull.

So looking at the autopsy, if the medical people here will help us if they can, looking at the horrible description of the damage to the brain, the hemorrhaging, the "purple contusions", etc., I have to wonder at ANY doctor who would claim this brain injury didn't "bleed enough" or display enough damage to have happened before the strangulation.

The brain is a very delicate organ. I wonder if this injury was catastrophic enough to result in near death, but also have the victim lingering for a longer time than has been spun by Team Ramsey. That the question, and the answer, I don't know.

It really is a crucial question, though, and I wish for ONCE we had a neurological expert to answer this question honestly and without prejudice!

 

medical questions (copied from # 464 post)

But it looks like there were only few:

Again, it would be interesting to compare them to petechiae in the lungs of a conscious victim who had been struggling against an attacker
strangling her with a ligature.

Anthother medical question: the autopsy report mentions "semifluid" blood in the vagina. Does this mean the victim died before the blood could completely coagulate (?)
How long does it take for blood to coagulate?

TIA for your help, Texan.

 

I would venture that the semifluid blood was in the process of coagulating when she died. Blood "gels" in a dead person. Then exsanguination eventually occurs if the body is undisturbed. Obviously JBR was found before this process, which would have been horrible to see. I don't know how much the Rs knew about the process of death, but they certainly knew (as any adult would) that the more time that elapsed before a dead body is found, the more "unpleasant" that discovery will be. That was reason enough for JR to run to that basement after the morning's police search failed to discover her body.
The autopsy report of the brain injury to me indicated what some experts have already said- it was a fatal injury that rendered her immediately unconscious, and took about an hour or less to kill her. The severity of the blow would have been immediately apparent to whoever was there, regardless of how much blood was visible. There was no going back. So in an attempt to save their own hides, they staged this despicable crime scene. This was the action of a classic narcissist, which profile I feel fits PR like a glove.

 

This is the way I see it too, DeeDee.

Does it ever!

 

Here is an article discussing the autopsy results of Richardson'w "blunt head injury", which was how she died. I'm putting it here because it describes "epidural hematoma" in a way I can understand. Now I'm trying to find out the difference between "epidural hematoma" and "subdural hemorrhage" and "subarachnoid hemorrhage" and and and...lord, can we HIRE a medical doctor to exoplain this to me?

http://omg.yahoo.com/news/autopsy-natasha-richardson-died-from-brain-injury/20204?nc

 

Here is a good website, which I am trying to decipher in my layperson's simple mind...not doing too well, but I'm TRYING!

http://www.pathguy.com/lectures/cns-all.htm

Again, here is the autopsy report on the skull and brain exam:

Okay, here are the questions I'm chasing:

What is the difference between a "hemorrhage" and "hematoma"?

If I'm understanding some of the text at this pathguy link, there would be no "infection" because the skin was not broken. Would that be why the ME Dr. Meyers said "No inflammation is identified." Or not? I know it has been said that "no inflammation" means there was no time for that to occur, so the injury came near the TOD. I have no idea, but this from the pathguy site is what has me asking: "An 'open' ("compound") skull fracture (i.e., one with an overlying tear in the scalp will, of course, serve as a portal of entry for bacteria." Obviously, as we know, JonBenet did not have an "overlying tear in the scalp"...? So no bacteria, no inflammation? Or is that something totally different in this context?

Okay, I have figured out "contusion" means bruising of the brain.

 

Okay, if you do NOT want to see a VERY GROSS PHOTO of a brain hematoma, DO NOT CLICK ON THIS LINK: GRAPHIC AUTOPSY PHOTO!

http://library.med.utah.edu/WebPath/CNSHTML/CNS020.html

It is described this way, which explains the differenct between a "hematoma" and a "hemorrhage"...sort of.

So here is the medical definition of "hematoma", and "subdural hematoma":

http://medical-dictionary.thefreedictionary.com/hematoma

Also from the above link, this definition and description may explain why the bleeding in the skull of JonBenet wasn't excessive, and therefore the time between the head injury and the strangulation could be longer:

And here is "subarachnoid hemorrhage" defined:

http://www.medterms.com/script/main/art.asp?articlekey=12415

 

Okay, dear Larry King just asked a doctor, "What is a hematoma?"

Doctor said, "It's simply a blood clot."

Thanks Larry.

They said "subdural" means beneath the "dura", or brain membrane, whereas "epidural" means above the "dura", or brain membrane, but they're BOTH inside the skull.

You now, I hate to say this, but I'm starting to think that JonBenet might have been conscious for a short time after the head blow. Is that the "scream" the neighbor heard?

Oh, that's a terrible thought, and something just shivered through me.

 

For those who believe JonBenet "fell" and that caused her head injury, here is a GRAPHIC PHOTO OF A BRAIN INJURY caused by a fall.

DO NOT CLICK IF YOU DO NOT WANT TO SEE A GRAPHIC AUTOPSY PHOTO OF A BRAIN WITH HEMORRHAGING:

http://library.med.utah.edu/WebPath/CNSHTML/CNS032.html

Here is what the caption says:

The characteristic location of the hemorrhage in this brain is consistent with a fall backwards resulting in a contracoup injury to the inferior frontal and temporal lobes. This has resulted in extensive contusions and subarachnoid hemorrhage.

Comparing this photo with the ME's description, it appears the hematomas were along the break in the skull, going from front to rear? There seem to be some contusion on the right and left temporal lobe, however, and I believe Sue or maybe Texan once spoke of these as possible evidence of some mild contrecoup injuries?

http://www.pathguy.com/lectures/cns-all.htm

 

Okay, NOW if I can only locate all the parts of the brain in this autopsy, I'll have a better idea of what the heck happened.

(I actually used to know a lot of this anatomy stuff, but oh, my poor brain must look terrible under all this gray hair since it has let go of so much memory now...sigh.... I think it's gone into retirement earlier than I planned.)

Here is a GREAT 3-D animation of the anatomy of the brain, and it's not gross or anything. It's from the Public Broadcasting System website, it's free, and it's easy enough for me to grasp. But you have to download a thingie, which my computer did without even asking and no problem, but just so you know....

http://www.pbs.org/wnet/brain/3d/

I keep repeating this part of the autopsy because in each post, the language is too much for me to remember, and I don't want to ikeep going up and down and up and down with the scroll button...sorry. :blush:

 

Bless your heart - but such research is a necessity....and it actually helped my brain start clicking this early in the morning. Eight inches of a little child's scalp is Huge.....and heartbreaking.