Biological Mechanisms behind Wischnewsky Spots Finding on Gastric Mucosa: Autopsy Cases and Literature Review

Abstract

Hypothermia is an emergency caused by the lowering of the central body temperature with a slowdown of basic vital functions. Reduced mobility, old age, psychiatric or metabolic disorders are relevant risk factors. Diagnosis of death from hypothermia is a challenge, as there are no pathognomonic signs, and supportive findings can be inconstant. Wischnewsky Spots (WS) are blackish lesions of gastric mucosa, typically associated with hypothermic death. The pathophysiology of these lesions is still uncertain. The aim of this paper is to investigate the pathological mechanisms determining the appearance of WS by analyzing the current scientific knowledge in this area. We performed a narrative review of the literature published in the last 20 years, comparing the results with three cases of hypothermia reported from our experience. The review proved that WS show a multifactorial etiology, i.e., not only body temperature decrease, but also various extrinsic and intrinsic factors, such as physical and psychological stress, agony, causa mortis and metabolic comorbidities. The review summarizes the current knowledge in the field of incidence, pathology and morphology of WS by proposing some scientific and technical points for clinical and forensic analysis of this phenomenon.

Wischnewsky spots in cases of fatal hypothermia in cattle

“…The formation of WS reported in humans is complex as they are associated with various factors, such as decreased body temperature, physical and psychological stress, and other comorbidities (Bright et al 2014, Sacco et al 2022. In animals, stress factors have also been identified as being associated with cases of hypothermia, such as neoplasia and starvation in dogs (Stern & Vieson 2017), multiple fractures in rabbits, and severe intestinal parasitism in monkeys (Almeida et al 2021).…”

“…A post-mortem finding observed in cases of cold stress is the occurrence of so-called "Wischnewsky spots" (WS), often described in autopsies of humans with hypothermia and characterized by red to dark brown spots on the stomach mucosa, which correspond to a superficial, non-erosive, and non-ulcerative hemorrhagic lesion of the mucosa (Tsokos et al 2006, Bright et al 2013a, Palmiere et al 2014, Sacco et al 2022. In other animal species, this finding is rarely described.…”

Hypothermia: Beyond the Narrative Review—The Point of View of Emergency Physicians and Medico-Legal Considerations

“…Among the internal findings in patients who have died with hypothermia, the presence of blackish erosions with a hemorrhagic background in the gastric mucosa, known as Wischnewski spots, have been described [126][127][128]. Acute pancreatitis [74,76] can be observed, as well, although it has been observed in less than half of all hypothermia deaths.…”