Bradley Burns death certificate and autopsy

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IT IS ILLEGAL T0 CE THIS IN ANY MANNBR <nx on Mensa WASED \i IJje Cotmmimoealtlf < Office of the Chief Medical Examiner REPORT OF AUTOPSY Name of Decedent: Bradley D. Burns M.E. Case # 2010-12778 Autopsy Performed by: Henry M. Nields, MD Date of Autopsy: 6/2/10 FINAL DIAGNOSES I. II. PARANOID SCHIZOPHRENIA (ANAMNESTIC) FOLLOWING REMOTE POLYSUBSTANCE ABUSE INCLUDING: LYSERGIC ACID DIETHYLAMIDE, MARIJUANA, KETAMINE, GAMMA HYDROXYBUTYRIC ACID AND ETHANOL A. STATUS POST PAST ELECTROCONVULSIVE THERAPY B. STATUS POST RECENT CLOZAPINE THERAPY 1. POST MORTEM BLOOD LEVEL = 4.3 MG/L C. STATUS POST RECENT MANAGEMENT WITH 5-POINT RESTRAINTS D. FOCAL SUBEPENDYMAL GLIOSIS OF BRAIN (SEE NEUROPATHOLOGY REPORT) MYXOID MITRAL VALVE, MILD CAUSE OF DEATH: PROBABLE CARDIAC DYSRHYTHMIA IN A PERSON WITH PARANOID SCHIZOPHRENIA FOLLOWING REMOTE POLYSUBSTANCE ABUSE (STATUS POST RECENT TREATMENT WITH ANTIPSYCHOTIC MEDICATIONS, INCLUDING CLOZAPINE, AND 5-POINT RESTRAINTS) MANNER OF DEATH: NATURAL COMMONWEALTH OF MASSACHUSETTS OFFICE OF THE CHIEF MEDICAL EXAMINER REPORT OF AUTOPSY CASE No. 10-12778 I, Henry M. Nields, M.D., Medical Examiner, hereby certify that I have performed an autopsy on the body of Bradley D. Burns on June 2, 2010 commencing at 12:30 p.m. at the Boston Office of the Chief Medical Examiner of the Commonwealth of Massachusetts. EXTERNAL EXAMINATION; The body is that of a well developed, well nourished, 5' 9", 182 Ibs., light skinned white male whose appearance is consistent with the given age of 34 years. The straight brown scalp hair measures approximately 2 1/2" in greatest length. The eyes have blue irides and clear conjunctivae which are free of petechiae or jaundice. The oral cavity has natural teeth and an atraumatic mucosa. There is no injury of the head, neck, chest, abdomen, back or upper or lower extremities. The penis is circumcised and there is no injury of the external genitalia. Focal perimortem injury of the chest will be described presently. There is a 1/8" unshaven beard and mustache. There is a tattoo of a cross on the anterior right shoulder region and the anterior left shoulder region. There is a tattoo of a skull with a design and a marijuana plant on the lateral aspect of the left upper thigh. POSTMORTEM CHANGES; Rigor is full and symmetric. Lividity is posterior and fixed. The body is cool to touch. CLOTHING; The body is unclothed. THERAPEUTIC PROCEDURES: There is an endotracheal tube in place. There is gauze covering a needle puncture site in the right antecubital fossa. There are defibrillator pads over the right upper chest and the left lateral lower chest. There are EKG pads over the left and right shoulder. INJURIES; There is a 3" x 3" red abraded contusion to the mid sternum. There is hemorrhage in the soft tissue of the upper anterior mediastinum and the lower anterior neck soft tissue. 2010-12778 Bradley D. Burns INTERNAL EXAMINATION: BODY CAVITIES: The thoracic and abdominal organs are in their normal anatomic relationships. There are no fibrous adhesions in the pericardial sac, pleural cavities or abdominal cavity. There are no abnormal fluid accumulations in the pericardial sac, pleural cavities or abdominal cavity. HEAD: The scalp has no contusion. The skull has no fracture. There is no epidural, subdural or subarachnoid hemorrhage. The brain weighs 1610 grams and is fixed for future neuropathological evaluation. NECK: The cervical vertebrae, hyoid bone, tracheal and laryngeal cartilages are without trauma. The upper airway is not obstructed. The tongue is unremarkable. CARDIOVASCULAR SYSTEM: There is minimal atherosclerosis of the aorta and iliac arteries. The venae cavae and pulmonary arteries are without thrombus or embolus. The heart weighs 300 grams and has a normal distribution of left predominant coronary arteries with no stenosis of the left anterior descending, left circumflex or right coronary arteries. The myocardium is uniform, firm, reddish brown and without focal abnormalities. The right ventricle is slightly dilated. The left ventricular wall measures 1.1 cm in thickness. The endocardial surfaces are unremarkable. The mitral valve measures 11 cm, the pulmonary valve measures 7.5 cm. the tricuspid valve measures 13 cm and the aortic valve measures 7 cm. There is slight myxoid degeneration of the mitral valve. RESPIRATORY SYSTEM: The right lung weighs 660 grams and the left lung weighs 610 grams. The lungs are dark red and markedly congested. There is no embolus or consolidation. The bronchial distribution and vasculature are unremarkable. LIVER, GALLBLADDER, PANCREAS: The liver weighs 1450 grams and has an intact capsule and reddish brown, firm parenchyma. The gallbladder contains approximately 15 cc of greenish brown bile and is unremarkable. The pancreas has normal lobulation, color, and texture. HEMIC AND LYMPHATIC SYSTEMS: The spleen weighs 210 grams, has an intact capsule and soft red parenchyma with normal white pulp. There are no lymph node enlargements. GENITOURINARY SYSTEM: The right kidney weighs 120 grams and the left kidney weighs 120 grams. Each kidney has a smooth subcapsular surface. The cut surfaces are firm, reddish brown and with unremarkable architecture. The vasculature is unremarkable. The left and right ureters are both patent. The bladder contains approximately 10 cc of yellow urine. The bladder wall, prostate and testes are unremarkable. ENDOCRINE SYSTEM: The pituitary, thyroid and adrenal glands are unremarkable. 2010-12778 Bradley D. Burns DIGESTIVE SYSTEM: The esophagus and gastroesophageal junction are unremarkable. The stomach contains approximately 20 cc of a brown fluid. There are no pills in the gastric contents. There is impacted stool in the descending colon which is dilated up to 7 cm. The small intestine, large intestine, and appendix are otherwise, unremarkable. MUSCULOSKELETAL SYSTEM: The vertebrae, clavicles, sternum, ribs and pelvis are without fracture. The musculature is normally distributed and is unremarkable. TOXICOLOGY: Samples of heart and femoral blood, urine, vitreous humor, bile and gastric contents are sent for toxicological evaluation. A sample of blood is saved at OCME. MICROSCOPIC DESCRIPTION: Heart: sections of heart with minimal interstitial and perivascular fibrosis. There is mild to moderate fatty infiltration of the right ventricular wall. Mitral Valve: section of heart valve with mild myxomatous changes. Lung: sections of lung with focal hemorrhages and focal acute bronchopneumonia. There are several collections of cocciform bacteria with minimal associated inflammation. Liver: section of liver with cholestasis. Kidneys: sections of kidney with congestion. Henry M. Nields, M.D. Medical Examiner 6/9/10/js/dft 8/31/10/HMN/FNL Commomoealtli o Office of the Chief Medical Examiner NEUROPATHOLOGY REPORT Name of Decedent: Bradley Burns M.E. Case # 2010-12778 Autopsy Performed by: Henry M. Nields, M.D. Date of Autopsy: 6/2/10 Brain Cutting by: Peter M.E. Cummings, M.Sc., M.D. Date Brain Cutting: 7/20/10 Neuro Gross Description I. Date Cut: 7/20/10 II. Gross Description of the Brain and Dura. A. Fresh Weight: 1610gm. B. Leptomeninges: 1. The leptomeninges are thin and transparent. C. Dura: 1. The dura is unremarkable. 2. All venous sinuses are patent. D. Vasculature: 1. The circle of Willis is intact without aneurysm or atherosclerotic disease. E. External Examination: 1. The brain is symmetric. 2. The gyri are of a usual pattern. 3. The cortical and ventral surfaces demonstrate no mass lesions or herniations. 4. The cerebellum is symmetric without herniation. 5. The cranial nerves are intact and symmetric. Gross Description of the Spinal Cord: 1. The spinal cord is not received for examination. 2010-12778 Bradley Burns G. Coronal Sections: 1. Coronal sectioning of the brain demonstrates a distinct gray/white junction. 2. There is no midline shift or hydrocephalus. 3. The deep nuclei are unremarkable. 4. The substantia nigra is adequately pigmented. 5. The cerebellum shows no gross abnormalities. H. Supplemental Techniques: 1. Photography - Yes. 2. Microscopic exam - Yes. I. Provisional Gross Impression: 1. Normal adult brain. Neuro Microscopic Description: A. Slide Description: 1. Hippocampus, 1 H&E 2. Basal ganglia, 1 H&E 3. Dentate nucleus and cerebellum, 1 H&E B. Microscopic Description: 1. 2. 3. Microscopic examination of the hippocampus demonstrates no diagnostic pathologic abnormality. Microscopic examination of the basal ganglia demonstrates a focus of subependymal gliosis. Otherwise, this section is unremarkable. Microscopic examination of the cerebellum dentate demonstrates no diagnostic pathologic abnormality. Final Neuropathology Diagnosis: 1. Mild subependymal gliosis of the basal ganglia. Peter M.E. Cummings, M.Sc., M.D. Forensic Neuropathologist 8/18/10/js/dft 8/24/10/PC/FNL UMassMemorial Med-_al Center, Inc. Forensic 1 .licology Report One Innovation Drive, Suite 330, Worcester, MA 01605 (5081793-6108 Amanda J. Jenkins, Ph.D., DFTCB, DABC, Director Matthew P. Juhascik, Ph.D., DABFT, Associate Director Ordering Location: XX-CMEB BOSTON- CME HEADQUARTERS 720 ALBANY STREET Boston, MA 02118 Ordering MD: Henry Nields, M . D . , P h D CASE NUMBER: CASE,CME10-12778 DECEDENT : BURNS, BRADLEY ACCT NUMBER XX000041997 ASE SEX 34 M Page : 1 FINAL REGI STER;ED: 0 $/ 0 3 /10 TEST Specimen Type SOLVENT SCREEN Methanol Ethanol Isopropanol Acetone DRUGS OF ABUSE Benzodiazepines Cocaine/Coc Metab Pentany1 Methadone Opiates Oxycodone Alkaline Drug Screen RESULT UNITS Blood ONE VIAL Fluoridated heart None JStene None None Detected Detected Detected Detected None None None None None None Detected Detected Detected Detected Detected Detected g% g% g% g% Diphenhydramine, lamotrigine, paroxetine, clozapine and norclozapine present. No other alkaline extractable drugs detected. TEST Specimen Type DRUGS OF ABUSE URINE Amphetamines Benzodiazepines Barbiturates Cannabinoids Opiates Phencyclidine Propoxyphene Cocaine/Coc Metab Methadone RESULT Urine None None None None None None None None None Detected Detected Detected Detected Detected Detected Detected Detected Detected ** CONTINUED ON NEXT PAGE ** UNITS UMassMemorial Med__al Center, Inc. Forensic 1 .icology Report One Innovation Drive, Suite 330, Worcester, MA 01605 (508)793-6108 Amanda J. Jenkins, Ph.D., DFTCB, DABC, Director Matthew P. Juhascik, Ph.D., DABFT, Associate Director Ordering Location: XX-CMEB BOSTON- CME HEADQUARTERS 720 ALBANY STREET Boston, MA 02118 CASE NUMBER: CASE,CME10-12778 DECEDENT : BURNS , BRADLEY ACCT NUMBER Ordering MD : Henry Nields , M . D . , PhD TEST Specimen Type SOLVENT SCREEN Mettianol Ethanol Isopropanol Acetone Clozapine Norclozapine AGE 34 FINAL SEX M RESULT UNITS Vitreous Humor None None None None TEST Specimen Type XX000041997 Page : 2 Detected Detected Detected Detected g% g% g% g% UNITS RESULT Blood ONE VIAL Fluoridated femoral 4300 (NMS) 2400 (NMS) TEST ng/raL ng/mL UNITS RESULT Specimen Type Fluid BILE UNITS RESULT TEST Specimen Type Fluid GASTRIC NMS - Test performed at NMS Labs, Willow Grove, PA OF REPORT ** SIGNATURE DATE