Brain Pathology Case of the Month - April 2012

Contributed by Fabio De-Giorgio, MD, PhD1, Vincenzo Arena, MD2, Francesco Turturro, MD 3 , Ernesto d'Aloja, MD, PhD 4, Massimo Miscusi, MD, PhD5
1Institute of Legal Medicine or 2Pathologic Anatomy, Catholic University, Rome, Italy
4Forensic Science Department, Cagliari University, SS 554 bivio Sestu, Monserrato (CA), Italy
Departments of 3Orthopedics and of 5Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy


CLINICAL HISTORY

A 11-year-old girl was operated on for a severe left thoracolumbar scoliosis (Cobb angle 65). Pedicular screws insertion and rod positioning was technically successful, but five days later, for signs of an early infection, a surgical wound revision was performed by debridement of necrotic tissues and hydrogen peroxide pressure irrigation of the operative field. Unexpectedly, during such procedure, the patient had two episodes of bradycardia followed by ventricular fibrillation, electromechanical dissociation, and pulmonary edema, and she died despite immediate resuscitation efforts.

GROSS PATHOLOGY

Autopsy demonstrated the correct positioning of pedicular screws and rods (Figure 1), with external signs of dehiscent wound in the lumbar region. No signs of pulmonary embolism nor associated cardiac defects, such as a patency of foramen ovale, were found. Gross examination of the brain, showed diffuse abnormalities in the cerebral veins (Figure 2, arrows).

MICROSCOPIC PATHOLOGY

Neuropathological examination is represented in Figure 3.

FINAL DIAGNOSIS


International Society of Neuropathology