Imaginary autopsy #1

I’ve made this case up to illustrate a point; any similarity to any real case is purely because I’ve chosen medical problems that are common.

A 58 year old man with a history of hypertension (high blood pressure) and a previous heart attack (myocardial infarction) was found dead at home. He had been completely well 3 hours earlier when he was last seen.

The autopsy shows widespread atheroma, an enlarged heart with left ventricular hypertrophy (thickened left ventricular wall) and myocardial fibrosis (scarring within the heart muscle), and triple vessel coronary artery atheroma. There was no visible coronary thrombosis (blood clot within the coronary artery) or obvious recent myocardial infarction.

Do you examine the brain?

Opening the skull to examine the brain is usually the last part of the autopsy to be done. Some coroners do not like you to open the skull if a cause of death has been found elsewhere, a problem discussd in the NCEPOD report into coronial autopsies. In this case the patient had severe heart disease, certainly enough to be a cause of sudden death. But it is not necessarily the cause of death.

The skull is opened and inside there is a massive subarachnoid haemorrhage from a berry aneurysm. This is the cause of death. These aneurysms are occasionally related to inherited diseases so finding this cause of death might have implications for this man’s relatives.

In cases like these where there is pressure not to examine an organ (but not a specific limitation on the extent of the autopsy) it can be difficult to decide what to do when a plausible, but not necessarily definite, cause of death is found such as severe heart disease. So is this autopsy a medical examination to determine the cause of death or a legal examination to determine that the death was natural, without as much thought to finding an accurate cause of death?