Table 3.

Final neuropathologic diagnoses based on available macroscopic photographs and paraffin blocks

I. (History of global cerebral hypoperfusion following therapeutic tonsillectomy at age 13, subsequently meeting clinical “brain death determination” guidelines, followed by maintenance on life support measures for 4½ years):

A. Portions of brain with: Widespread autolysis (resembling “mummification,” “saponification”), with acellular degenerative changes, of deep cerebral and cerebellar cortex and white matter, consistent with near-total absence of perfusion and reperfusion; Focal partial revascularization of superficial cerebral and cerebellar cortices, with microscopic macrophage infiltrates, mineralization, old and recent microhemorrhage, consistent with old hypoxia-ischemia and limited reperfusion, apparently from dura mater (external carotid and vertebral arterial blood flow).

B. Portions of dura mater with: Obliteration and recanalization of venous sinuses; Intradural iron deposition, consistent with old hypoxia-ischemia and reperfusion; Fibrous adhesion of convexity and tentorial meninges to superficial cerebral and cerebellar cortex; Recent-on-subacute-on-chronic submeningeal hemorrhage, with focal extension into superficial cerebral and cerebellar cortices; Thick epidural extramedullary hematopoiesis (marrow metaplasia); Focal autolysis (resembling “mummification”, “saponification”).