This review compares and contrasts the preclinical pharmacology of bromperidol with another butyrophenone neuroleptic, haloperidol, and the phenothiazine neuroleptic chlorpromazine. Its pharmacokinetics, biotransformation, and safety in several laboratory animal species are also summarized. These preclinical data support its use as an antipsychotic agent and show that it is well absorbed following oral administration with an apparent elimination half-life of approximately 24 h, supporting a once-daily dose regimen. Animal toxicity (including acute- and multiple-dose toxicology and reproductive and mutagenicity studies) show that bromperidol is well tolerated.
Endosulfan is a highly toxic agricultural pesticide that has been banned in many countries due to its significant neurotoxicity and environmental persistence. Accidental or intentional ingestion by humans induces severe neurological symptoms, which frequently culminate in coma or death. Forensic evaluation of suspected endosulfan toxicity cases can be challenging, given that endosulfan residue may not be detectable in the blood or tissues at the time of death. As such, evaluation of the case history in the context of the reported literature becomes extremely important. Although acute endosulfan toxicity in adults has been well documented, pediatric cases are rare within the literature. Here we present the case of a toddler who accidentally ingested an unknown quantity of endosulfan from an unmarked water bottle on his family farm. The child developed rapid-onset neurological symptoms, including vomiting and seizures, followed by coma. Despite medical intervention, the child was eventually pronounced brain dead and taken off life support. Autopsy revealed massive cerebral edema and its sequelae (sutural diastasis, pituitary necrosis, and dural venous thromboses), and pulmonary thromboemboli. Endosulfan was detected in the bottle from which the child drank. As endosulfan was not detectable in postmortem blood, the cause of death was certified based upon the totality of available information including history, consistency of the case history with the clinical presentation, and the autopsy findings.
The clinical or forensic pathologic evaluation of an infant with an apparently inflicted head injury can be challenging, particularly when objective findings are limited to the classic triad ascribed to “Shaken Baby Syndrome” – subdural and retinal hemorrhages and anoxic brain injury. These three findings together, in the absence of an apparent impact site (scalp or skull injury) have a controversial differential diagnosis. However, the discovery of an impact site of virtually any size is sufficient for some forensic pathologists to make the diagnosis of homicidal (impact) blunt head trauma in babies with limited additional evidence of abuse, or with the classic triad, but without careful consideration of its differential diagnosis. Although relatively uncommon in modern intensive care units, occipital scalp ulcers can and do occur, and may mimic the appearance of a blunt impact site. Two separate cases of infant death are presented to illustrate the nature and appearance of occipital pressure ulcers. Abnormalities of the occipital scalp were not detected in either infant upon hospital admission, but scalp lesions were clearly observed at autopsy. Macroscopically, these lesions closely resembled blunt impact sites. They were determined to be pressure ulcers based predominantly on the histologic findings of epidermal thinning and dermal homogenization, combined with the absence of both hemorrhage and stainable free iron. Further supportive factors were the absence of skull fractures, intracranial hemorrhages, and cerebrocortical contusions.
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