MED02 SOUTHWESTERN o INSTITUTE OF.FORENSIC SCI~NCES 5230 Medical Center Drive Dallas, Texas 75235 Case No. JP3854-00-2771JM N~e: Vas, Isis Charm Race: White Sex: Female Age: 6 months Date of Death: 29 OCT 2000 Time of Death: 10:45 am Date of Examination: 31 OCT 2000 Time of EX,amination: 8; 00 am Pronounced at: Northwest Texas Medical Center Amarillo, Potter County, Texas AUTOPSY REPORT: ORGAN WEIGHTS: Brain Heart 790 g R. Lung L. Lung Spleen 62 g R. Kidney L. Kidney *Harvested of the Peace, 23 g 53 g o Liver * * This autopsy is performed at the request of Haven Dysart, Justice Precinct 3, Potter County, Texas. EXTERNAL EXAMINATION, The body is identified by toe tag. Photographs and body is not embalmed. The hands are not bagged. footprints are taken. The The body is received wearing a disposable diaper which is discarded. Also discarded are hospital blankets and a hospital sheet. No jewelry is present on the body. The body is that of a white female infant appearing the stated age of 6 months. The body measures 38 cm (15.0 in) in crown-rump length, 56 cm (22 in) in crown-heel length, 40 cm (1S.7 in.) in chest circumference, 42-1/2 cm (16.7 in.) 'in head circumference, and 7 cm (2.8 in) in foot length. The body weighs 12 pounds (5.44 kg) . Rigor mortis is generalized, and postmortem lividity is reduced and ill-defined on the posterior aspect of the body. Livor mortis is purple and fixed. The body is cold to touch. The scalp hair is dark blond. The eyes are brown and no petechiae are noted. The mouth is edentulous and there are no injuries of the frenulum, cheeks, or gums . o STATE-0443 Case No, Name, JP3854-00-2771JM Vas, Isis Charm 'MED03 Page 2 o The palate is intact. The neck, chest, abdomen, back, and extremities are unremarkable, except for evidence of blunt force injuries. The external genitalia are those of a female infant (see injury section) . EvIDENCE OF MEDICAL THERAPY, EKG pads are noted. There is an oral gastric tube. A three-line IV is present in the left subclavian region. A Foley catheter is noted. There is a temperature monitor. Needle puncture marks covered with bandage are noted of both lower legs. There are needle puncture marks of the right heel and right wrist. EVIDENCE OF ORGAN HARVESTING FOR PURPOSES OF TRANSPLANTATION: There is a midline surgical incision of the anterior trunk. The spleen and liver have been removed prior to autopsy. By history, there is no injury noted of the liver or spleen. EVIDENCE OF INJURY, BLUNT FORCE INJURIES OF THE HEAD: The forehead shows five separate areas of purple contusion ranging from 3/8 of an inch to 1/2 inch in greatest dimension. There is an area of ecchymoses of the medial aspect of the right upper eyelid. Lateral to the left eye, there is a 3/8 inch purple contusion. The left cheek shows a 1/2 inch purple. contusion. There is a red contusion of the tip of the nose that measures 3/16 of an inch in greatest dimension. The left lateral chin shows a 1/2 inch area of purple contusion. The right side of the head above the ears shows a 1/2 inch blue contusion. Above and lateral to the right eyebrow, there are two purple contusions measuring 1/4 and 3/8 inches. The back of the head shows a 1-1/2 x 7/8 inch area of abrasion. The left side of the posterior aspect of the head shows a 3/8 inch area of contusion. Subscalpular hemorrhage is noted of the posterior occipital region of a~d the midline parietal occipital region of the head. There is a rightsided subdural hemorrhage consisting of right cerebral hemisphere. A few clots of blood are noted. liquid blood the head o of the The brain is saved for further examination by the Department of Neuropathology. BLUNT FORCE INJURIES OF THE TRUNK: There is a 3/4 inch area of purple contusion of the left lateral chest. ~LUNT FORCE INJURIES OF THE PELVIC REGION: ar~ two blue contusions noted in the anterior hip region, :;-)ntU:':i..::m.:; ;.'.easure 5/8 and'3/4 inches in greatest dimension . The=e ").''';i.~;':_. bilaterally. o ' STATE?0444 MED04 Case No: Name: JP3S54-00-2771JM Vas, Isis Charm Page 3 o Examination of the genitalia shows a 1/2 inch lacerated area of the posterior fourchette. There is extensive soft tissue hemorrhage surrounding this area of laceration. The anus is examined and shows of the anus. focal faint contusions surrounding the entrance BLUNT FORCE INJURIES OF THE BACK: There is a punctate area of contusion of the right side of the upper back. There is 3/8 inch blue contusion of the midportion of the back. Reflection of the skin of evidence of injury. the back and posterior neck dissection reveal no BLUNT FORCE INJURIES OF THE EXTREMITIES: There is a brown cont~sion of the left lateral lower leg. There is a l/S inch blue contusion of the right thigh. There is a 3/S inch purple contusion of the left thigh. INTERNAL EXAMINATION: '. The injuries have previously been described and will not be repeated. Apart from the features described above, examin~tion of the organs and tissues which comprise the HEAD, CENTRAL NERVOUS SYSTEM, NECK, BODY CAVITIES, CARDIOVASCULAR, RESPIRATORY HEPATOBILIARY GENITOURINARY, GASTROINTESTINAL, LYMPHORETI CULAR, ENDOCRINE, and MUSCULOSKELETAL SYSTEMS reveals all to be within the usual limits of size, character and position for age, sex, and development. I I In particular, there is cerebral edema. The stomach contains 3 ml of greenish bile stained fluid. The bladder is empty. The appendix is present. The kidneys are pale. The fontanelle is tense. The sutures are slightly spread due to cerebral edema. EXAMINATION OF BRAIN FOLLOWING FORMALIN FIXATION: There is thin (0.2 cm thick) right subdural hemorrhage. There is marked softening and gray discoloration of the friable cerebral parenchyma. There is focal subarachnoid hemorrhage in the right occipital pole and left frontal poles. There is patchy subarachnoid hemorrhage over the convexity of the right cerebral hemisphere. Blood clot fills the right lateral ventricle. Horizontal sectioning of the brainstem and cerebellum reveals marked softening with no focal lesions. External examination of the spinal cord and serial cross sections demonstrate no gross abnormality. MICROSCOPIC EXAMINATION: Soft tissue (vaginal area) - recent hemorrhage. Subscalpular tissue - recent hemorrhage . a o STATE-0445 MED05 Case Name I NOI JP3854-00-2771JM Vas, Isis Charm Page 4 o Thymus - mild "starry-sky" appearance. Adrenal - no pathologic diagnosis. Heart - no pathologic diagnosis. ~ Lung ...- atelectasis; bronchopneumonia; congestion. Heart - no pathologic diagnosis. Kidney - congestion. Dura - recent hemorrhage. Larynx, Thyroid - no pathologic diagnosis. Left eye - recent retinal hemorrhage and perioptic hemorrhage. Right eye - recent retinal hemorrhage and perioptic hemorrhage. o Brain - light microscopy of sections of dura mater demonstrates fresh hemorrhage within and attached to the undersurface of the dura. Sections of the internal capsule region and cerebellum demonstrate acutely necrotic neurons (red cytoplasm and pyknotic nuclei) consistent with preterminal global hypoxic/ischemic damage. There is fresh intraventricular hemorrhage in association with the choroid plexus. The pons demonstrates congestion and petechial hemorrhage. Sections of neocortex demonstrate perivascular rarefaction, possibly representing edema. The spinal cord is histologically unremarkable . o STATE-0446 MED06 Case Nos Name, JP3854-00-2771JM Page 5 Vas, Isis Charm -" o ...... FINDINGS; 1. Blunt force injuries of the head with: a. b. c. d. e. f. g. h. 2. Contusions. Subscalpular hemorrhage. Subdural hemorrhage. Recent intraventricular hemorrhage. Scattered acutely necrotic neurons, consistent with hypoxic/ischemic damage. Petechial hemorrhage, pons. Retinal hemorrhages. Perioptic hemorrhage. preterminal global Blunt force injuries of the pelvis: a. b. c. Laceration of the posterior fourchette hemorrhage. Faint contusions surrounding the anus. Contusions. with extensive soft tissue 3. Blunt force injuries of the trunk, back, and extremities: a. Contusions . o (Continued on next page) o STATE-0447 MED07 Case No! Name I JP3854-00-2771JM Vas, Isis Charm Page, 6 o CONCLUSION: It is my opinion that Isis Charm Vas, a 6-month-old white female, died result of multiple blunt force injuries. MANNER OF DEATH: Homicide. as the ~/-J,'Dr\C~~ ~~L. McClain, M.D. Medical Examiner '1'0XICOLOGY: Blood: Alcohols and Acetone - negative. Cannabinoid Screen - negative. Drug Screen - 0.05 mg/L lidocaine. Lynn A. Salzberger, M.D. Medical Examiner ~jJ~p~)n:O Medic~l Exami~e~ J. K. Townsend-Parchman, M.D. /L.lerJpc-t1woc~} 0 o Protocol typed by Maybelle Doughty, Sheila Spotswood, M.D. M~l Examiner Jen()e~ DU~l~ Medi~ Examiner J. D~eputY~:r , rw J. Barnard, M.D. Ch'ef Medical Examiner l!1//!j)~. '/' MGUile~do, M.D. o STATE-0448