Fatal hemorrhage complicated with methamphetamine poisoning and its post-mortem CT features
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ORIGINAL ARTICLE
Fatal hemorrhage complicated with methamphetamine poisoning and its post-mortem CT features Maiko Yoshida 1 & Yohsuke Makino 1,2 & Yumi Hoshioka 1 & Fumiko Chiba 1,2 & Go Inokuchi 1 & Suguru Torimitsu 1,2 & Rutsuko Yamaguchi 1 & Ayumi Motomura 3 & Hiroko Abe 1 & Daisuke Yajima 3 & Hirotaro Iwase 1,2 Accepted: 28 July 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract The purpose of this study was to assess the incidence of fatal hemorrhage complicated with methamphetamine (MA) poisoning and to examine the postmortem computed tomography (PMCT) features of fatal intracerebral hemorrhage (ICH) with and without MA poisoning. The study also attempted to determine the differences in PMCT between those two groups. Consecutive medicolegal autopsy data from November 2011 to February 2018 were searched for 3044 cases. First, the incidence and distribution of all cases of nontraumatic fatal hemorrhage with various causes were examined. Second, cases of ICH on the basal ganglia and brain stem were extracted. The PMCT findings were compared with respect to nine parameters: volume of hematoma, ventricular perforation, midline shift distance, aortic calcification, calcification of aortic valve, calcification of coronary artery, cardiothoracic ratio, circumference of ascending aorta, and volume of bladder contents. Of the 3044 cases, 97 were nontraumatic fatal hemorrhage; of these 97 cases, 20 were classified as MA poisoning with 9 ICH cases, and 60 cases were classified as non-MA poisoning with 14 ICH cases. A statistically significant difference in ages was observed between the two groups. On PMCT comparison of ICH, statistically significant differences were evident in the midline shift distance and calcification of the aortic valve. Forensic radiologists should be aware of the possibility of ICH with MA poisoning if fatal hemorrhage is detected on PMCT. Younger age, less calcification of the aortic valve, and a remarkable midline shift may be the keys to recognition. Keywords Fatal hemorrhage . Intracerebral hemorrhage . Methamphetamine poisoning . Postmortem computed tomography
Introduction The use of illicit drugs is a significant global health issue because these drugs are associated with premature mortality and morbidity. The World Health Organization has estimated Electronic supplementary material The online version of this article (https://doi.org/10.1007/s12024-020-00294-5) contains supplementary material, which is available to authorized users. * Maiko Yoshida [email protected] 1
Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, Chiba Prefecture, Japan
2
Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan
3
Department of Legal Medicine, International University of Health and Welfare, 4-3, Kozunomori, Narita, Chiba Prefecture, Japan
that 450,000 people died of drug use in 2015, and 167,750 cases of such deaths were directly associ
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