Medico-Legal Journal

The suitability of an unregistered expert psychologist to give evidence to the Family Court was considered in Re C [2023] EWHC 345 (Fam). An important part of the judgment focused on the need for an expert witness to demonstrate, in a short, concise and relevant CV, why they have the expertise to give opinion evidence in the case. The judgment has important implications for experts in civil litigation, where the same issues arise. The case of Re C is reviewed and recommendations for a new format for part of expert reports provided in civil litigation are discussed.

Capacity, often linked with the exercise of patient autonomy, was considered again recently by the Court of Appeal in Thirumalesh Chellamal Hemachandran and Another v Sudiksha Thirumalesh (Deceased) (By her litigation friend, The Official Solicitor) and Others ([2024] EWCA Civ 896). This paper reviews that case and comments on it in the light of the two related key themes of capacity and patient autonomy. The paper concludes that only patients with capacity can exercise patient autonomy because a patient who lacks capacity cannot make a decision regarding their medical treatment.

Post-mortem examination of the eye provides valuable forensic information yet is often overlooked. This brief review focuses on determining the cause/manner of death and post-mortem interval. External eye findings like corneal haziness and tache noire, combined with post-mortem changes in the iris, lens, retina and vitreous humour, can help estimate time since death. Ocular biometrics (iris/retinal scans) may facilitate identification. Age-related ocular changes can provide insights. The eye offers clues into personality (corneal tattooing, trichotillomania) and cause of death (petechiae in strangulation, retinal haemorrhages in abusive head trauma). Ocular trauma and underlying eye disease may be evident. Toxicology of vitreous humour can detect drugs/poisons. As a window into systemic disease and age-related changes, the eye aids pathology interpretations and, accordingly, post-mortem examinations have value. Ocular findings should not be overlooked in forensic examinations as they provide distinct information in determining cause/manner of death and post-mortem interval.

Sudden death from haemopericardium as a result of a right atrial rupture is uncommon, most particularly when this occurs spontaneously without any prior trauma or evidence of atrial wall pathology. The deceased was a 32-year-old man. At lunchtime his symptoms of unease, giddiness and unconsciousness began and within 45 minutes he arrived at the hospital. His vitals could not be recorded in the emergency department, and after CPR, he was pronounced dead. At autopsy, an isolated right atrial rupture, without any disease of the heart wall, was discovered. The right atrium has the weakest wall and is frequently the site of spontaneous rupture brought on by increased intraluminal pressure. Both liquid blood and clotted blood were found in the pericardial cavity. Low atrial pressure encourages clot formation because it causes considerably slower blood entry into the pericardium at the time of atrial rupture compared with entry at the time of ventricular rupture. Evidence of chronic lung disease was found which explains the raised intraluminal pressure of the heart chambers. Even with no history of trauma or myocardial infarction, the Beck triad – an engorged neck vein, a muffled heart sound, and low blood pressure – should alert the emergency room staff to the possibility of cardiac tamponade because, in a very unlikely scenario, spontaneous cardial wall rupture might occur.

We describe a rare case of severe primary spondylitis caused by Streptococcus gordonii in a 45-year-old immunocompetent woman with no relevant comorbidities. The surgical site infection arose after a L4–L5 microdiscectomy and resulted in severe clinical disability. Allegations of possible negligence as the cause prompted a forensic review to clarify the original source and transmission of this uncommon pathogen, which dismissed its cause as due to malpractice during treatment.

Duplex kidney, a rare congenital anomaly characterised by dual urinary drainage from the kidney, is typically discovered incidentally, often during radiological imaging or autopsy procedures. We report a case of a 21-year-old male who died from injuries sustained in a road traffic accident. The autopsy examination showed an incidental finding of duplex kidney on the left side. We discuss the clinical and potential medico-legal significance of duplex kidney which also has implications in renal transplantation. Notably, the presence of duplex kidney can potentially serve as an identifier in forensic investigations, given its rare incidence.

In cases of traumatic deaths, accurate assessment of injuries is essential for both legal and medical purposes. This case report compares the findings of post-mortem computed tomography with conventional autopsy methods in assessing abdominal stab wounds. A 34-year-old woman with multiple stab wounds in the abdomen underwent post-mortem examination, including computed tomography imaging. Computed tomography revealed specific breaches in the skin's continuity and internal injuries, including perforation of the stomach. A conventional autopsy confirmed the presence of multiple stab wounds and associated injuries to internal structures. However, additional injuries to major blood vessels, such as the abdominal aorta and inferior vena cava, were only detected during manual exploration of the peritoneal cavity. This case highlights the complementary roles of post-mortem computed tomography and conventional autopsy in evaluating traumatic injuries. While computed tomography imaging offers non-invasive visualisation of injuries, manual examination remains essential for identifying certain injuries, particularly those affecting major blood vessels. The integration of computed tomography imaging with traditional autopsy methods enhances the accuracy and reliability of forensic assessments in cases of traumatic deaths, particularly in complex cases involving multiple injuries. Understanding the strengths and limitations of these techniques is crucial for improving forensic investigations and ultimately enhancing medico-legal outcomes.

We report an unusual and undetected case of primary central nervous system lymphoma presenting as multiple lesions in the periventricular occipital lobe in an immunocompetent host, which had manifested as a stroke. The neoplastic diagnosis was made only after death following a thorough autopsy and histopathological examinations which enabled the diagnosis of a rare cancer (primary cerebral lymphoma) which remained undetected and undiagnosed during life.