title: Diagnosis of Alzheimer's disease in an exhumed decomposed brain after twenty months of burial in a deep grave.
abstract: After 20 months of interment in a deep grave, the decomposed body of the 81-year old testator of a will was exhumed to sustain the burden of proof that he lacked testamentary capacity when the will was rewritten two days prior to his death. The brain was mushy and pulverized with complete disappearance of the brainstem, cerebellum and subcortical ganglia. Small foci of relatively intact dorsal frontal neocortex were identified. Sections from these foci were stained with hematoxylin and eosin, bielchowsky silver stain and immunostains for beta amyloid peptide (betaA4), tau and alpha-synuclein. Despite severe autolysis and decomposition, the bielchowsky stain and the betaA4 immunostains showed preserved frequent neuritic amyloid plaques with very few residual neurofibrillary tangles. Cerebral Amyloid Angiopathy was present. At the present time this case represents the first documented and reported case of direct tissue diagnosis of Alzheimer's Disease pathology in a decomposed brain following long term burial in a deep grave.
authors.affiliation: Divisions of Forensic Pathology and Forensic Neuropathology, Allegheny County Coroner's Office, Pittsburgh, PA, USA. bennet.omalu@verizon.net
authors.forename: Bennet I
authors.initials: BI
authors.lastname: Omalu
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Mancuso
authors.forename: Patrick
authors.initials: P
authors.lastname: Cho
authors.forename: Cyril H
authors.initials: CH
authors.lastname: Wecht
mesh_terms: D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000175:diagnosis*; D016229:Amyloid beta-Peptides / Q000378:metabolism; D001329:Autolysis / Q000473:pathology; D001921:Brain / Q000473:pathology*; D016657:Cerebral Amyloid Angiopathy / Q000473:pathology; D049249:Exhumation; D049429:Forensic Pathology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D016874:Neurofibrillary Tangles / Q000473:pathology; D058225:Plaque, Amyloid / Q000473:pathology; D011180:Postmortem Changes; D013194:Staining and Labeling
chemical_list: D016229:Amyloid beta-Peptides