Autopsy Procedures Research Articles

Fetal autopsy: Clinicopathologic correlation in consecutive cases

Background: Fetal and neonatal mortality serves as the most sensitive index of maternal and neonatal care. Congenital malformations remain a common cause of perinatal deaths and account for 10–15% in developing countries. Antenatal anomaly scan has become a standard element of obstetric care and their time for a fetal malformation is about 18 weeks. Fetal autopsy serves as a methodology to confirm the sonogram findings with regard to fetal anomalies. Aims and Objectives: The aim of our present study is to review and evaluate fetal autopsy of stillbirth/fetal losses and to confirm the malformations that were diagnosed by ultrasound. Materials and Methods: A cross-sectional study of a total of 10 cases received during the period of September 2023–October 2023 at the Institute of Obstetrics and Gynaecology. All the cases were spontaneous fetal losses. A standard protocol of autopsy procedure was followed which included external, internal, and histopathological examination. In fetuses with prenatally diagnosed malformations, ultrasound findings were compared with autopsy findings. Results: We analyzed a total of 10 fetuses, which included one chromosomal abnormality, four cardiac anomalies, one multiple anomaly, three central nervous system (CNS) anomalies, and one lethal skeletal dysplasia. The fetal autopsy confirmed the prenatal ultrasound findings in eight cases. Fetuses with CNS abnormality were not appreciated grossly due to early autolysis of the brain in the post-mortem. Conclusion: Prenatal imaging and screening are considered milestone development which detects fetal anomalies. However, the time-tested clinical autopsy which used to be conducted for all hospital deaths to find the cause of death was the norm of yesteryears which threw light on many unidentified causes and many syndromic associations not detected antemortem. Likewise, this case highlights the importance of autopsy correlation with prenatal imaging to highlight the same findings and to detect findings not picked up during imaging.

Zdjęcia online i prawnie chronione tajemnice: możliwe konsekwencje prawne publikowania zdjęć zwłok przez personel sekcyjny

Photographs of human remains, including those captured during post-mortem examinations, are occasionally shared on social media for various reasons, extending beyond purely scientific purposes. critical questions regarding the ethical and legal boundaries concerning the publication of such materials. Notably, there is no overarching legal prohibition on the photography and dissemination of human remains. Consequently, each case demands an individual assessment, grounded in the principles of criminal law, civil liability, and ethics, particularly in the context of medical practices. This article offers a comprehensive analysis of the potential legal frameworks applicable to instances where photographs of corpses, taken during or related to autopsies, are published on social media platforms. The analysis encompasses legal guidelines governing autopsy procedures, regulations protecting the confidentiality of preparatory proceedings, the safeguarding of professional and functional secrets, laws against the desecration of corpses, and the upholding of personal rights.

Added value of postmortem mri in sudden unexpected infant death cases.

We aimed to investigate the potential added value of postmortem MRI (PMMRI) in sudden unexpected infant death (SUID) cases referred to our center between September 2020 and June 2023. Ultimately, 19 SUID cases underwent PMMRI alongside standard autopsy procedures, which included technical examinations such as postmortem CT (PMCT). Four radiologists, two with prior PMMRI experience, provided structured reports following consensus. For each case, the responsible forensic medicine specialist documented the cause of death before and after reviewing the PMMRI report. Additionally, they assessed the overall impact of the PMMRI report and had the opportunity to provide written comments. The results of our study indicate that none of the PMMRI reports altered the prior determined cause of death, which included cases of infection, asphyxia, and sudden infant death syndrome (SIDS). However, we observed a moderate impact in one case and a low impact in 10 cases. The moderate impact arose from the PMMRI report identifying hypoxic-ischemic changes, where histologic examination of the brain was perceived as normal. Conversely, in the 10 cases with a low impact, the PMMRI reports supported the autopsy findings, specifically indicating brain injury and intra-alveolar cellular infiltrates. In conclusion, our study suggests that while PMMRI may not be pivotal in determining the cause of death in SUID cases, it could aid in detecting hypoxic-ischemic changes and reinforcing brain and lung observations. However, distinguishing genuine lung pathology from postmortem changes using PMMRI remains challenging. Further research is warranted to clarify the role of PMMRI in forensic SUID investigations.

Parameter Estimation of Birnbaum-Saunders Distribution under Competing Risks Using the Quantile Variant of the Expectation-Maximization Algorithm

Competing risks models, also known as weakest-link models, are utilized to analyze diverse strength distributions exhibiting multi-modality, often attributed to various types of defects within the material. The weakest-link theory posits that a material’s fracture is dictated by its most severe defect. However, multimodal problems can become intricate due to potential censoring, a common constraint stemming from time and cost limitations during experiments. Additionally, determining the mode of failure can be challenging due to factors like the absence of suitable diagnostic tools, costly autopsy procedures, and other obstacles, collectively referred to as the masking problem. In this paper, we investigate the distribution of strength for multimodal failures with censored data. We consider both full and partial maskings and present an EM-type parameter estimate for the Birnbaum-Saunders distribution under competing risks. We compare the results with those obtained from other distributions, such as lognormal, Weibull, and Wald (inverse-Gaussian) distributions. The effectiveness of the proposed method is demonstrated through two illustrative examples, as well as an analysis of the sensitivity of parameter estimates to variations in starting values.

Duplex kidney: An incidental autopsy finding of clinical and medico-legal significance.

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.

The Association between Visceral Adipose Tissue and Coronary Atherosclerosis in Thai Postmortem Cases

Objective: To determine the correlation between visceral adipose tissue (VAT) and degree of coronary artery stenosis in the Thai population. Materials and Methods: This prospective cross-sectional study was conducted in 220 Thai postmortem cases. Sex, age, weight, height, waist and hip circumferences were recorded for each case. The intra-abdominal VAT weight of each site was assessed during the autopsy procedure, and degrees of stenosis for three coronary arteries (left anterior descending artery (LAD), right coronary artery (RCA) and left circumflex artery (LCX)) were evaluated in histological examination. Descriptive statistics, bivariate correlation, and multivariate linear regression were used to determine the correlations between VAT and degrees of coronary artery stenosis. Results: There were 108 female and 112 male subjects with a mean age of 45.95 years old. Waist circumference, waist-hip ratio and VAT in the male subjects were significantly higher than in the female subjects (p<0.001). VAT was well correlated with waist circumference and waist-hip ratio (p<0.001). VAT weights were positively correlated with degrees of LAD, RCA and LCX stenosis, with coefficient correlations (r) of 0.561, 0.453 and 0.451, respectively (p<0.001). Mesenteric and peri-renal adipose tissues produced better correlations than the other sites. Multivariate linear regression showed that sex and age were correlated with stenosis in all three coronary arteries (p<0.001), and mesenteric and peri-renal adipose tissues had strong correlations with LAD stenosis (p<0.001). Conclusion: VAT weights from all sites were correlated with degrees of coronary artery stenosis. Mesenteric and peri-renal adipose tissues produced better correlations than the other sites.

Nrf2 expression, mitochondrial fission, and neuronal apoptosis in the prefrontal cortex of methamphetamine abusers and rats

Methamphetamine (MA), a representative amphetamine-type stimulant, is one of the most abused drugs worldwide. Studies have shown that MA-induced neurotoxicity is strongly associated with oxidative stress and apoptosis. While nuclear factor E2-related factor 2 (Nrf2), an antioxidant transcription factor, is known to exert neuroprotective effects, its role in MA-induced dopaminergic neuronal apoptosis remains incompletely understood. In the present study, we explored the effects of MA on the expression levels of Nrf2, dynamin-related protein 1 (Drp1), mitofusin 1 (Mfn1), cytochrome c oxidase (Cyt-c), and cysteine aspartate-specific protease 3 (Caspase 3), as well as the correlations between Nrf2 and mitochondrial dynamics and apoptosis. Brain tissue from MA abusers was collected during autopsy procedures. An MA-dependent rat model was also established by intraperitoneal administration of MA (10 mg/kg daily) for 28 consecutive days, followed by conditioned place preference (CPP) testing. Based on immunohistochemical staining and western blot analysis, the protein expression levels of Nrf2 and Mfn1 showed a decreasing trend, while levels of Drp1, Cyt-c, and Caspase 3 showed an increasing trend in the cerebral prefrontal cortex of both MA abusers and MA-dependent rats. Notably, the expression of Nrf2 was positively associated with the expression of Mfn1, but negatively associated with the expression levels of Drp1, Cyt-c, and Caspase 3. These findings suggest that oxidative stress and mitochondrial fission contribute to neuronal apoptosis, with Nrf2 potentially playing a critical role in MA-induced neurotoxicity.

A study about Knowledge and Perception of Medical Students Towards Autopsy and Attitude Towards Forensic Medicine as a Career option

ntroduction: The questionnaire based study was carried out with the objective to know the present knowledge of students regarding autopsy, attitude towards autopsy and probability of choosing forensic medicine as a career which can enable to find out ways to make autopsy an enriching academic exercise and further increase the acceptability of our subject. Methodology: A questionnaire based cross-sectional study, was carried out among the 2nd year medical students at IMS and Sum Hospital, Bhubaneswar. The first part of questionnaire comprised of items in form of simple statements for which response recorded dichotomously as true or false. The first nine statements were on knowledge component and second nine items were on attitude of the students. The second part of questionnaire comprised of eight items which contained the eight reasons for forensic medicine of not choosing forensic medicine as career. Results: A majority of students were found to have reasonable knowledge of the basic autopsy procedure. 88% of the students were of the opinion that autopsy has utility in medical education. 68% of the students were confident of independently performing an autopsy. 88% of students proactively searched for information on autopsy. However only 11.54% students reported that they plan to pursue a career in Forensic Medicine.

A Review Article on the Transformative Impact of Artificial Intelligence-powered Autopsy in Forensic Medicine

Forensic medicine has traditionally relied on conventional autopsy methods for determining the cause of death and supporting criminal investigations. However, the introduction of artificial intelligence (AI) has sparked a new era in forensic medicine, fundamentally altering the autopsy process. This comprehensive review investigates the transformative impact of AI-powered autopsy techniques on forensic medicine, emphasizing the advancements, challenges, and future possibilities. Through a meticulous analysis of current research and case studies, the article illustrates how AI significantly improves accuracy, efficiency, and objectivity in forensic investigations, resulting in more dependable outcomes. The integration of AI into autopsy procedures represents a revolutionary shift in forensic medicine, with emerging technologies and methodologies reshaping investigative practices. Alongside traditional autopsies, the utilization of VIRTOPSY—an advanced imaging technique—is increasingly prominent, further enhancing the forensic examination process. By delving into recent advancements, applications, and potential developments, this review provides a holistic overview of how AI is reshaping forensic investigations, enhancing reliability, and contributing to justice. This review underscores the transformative role of AI in forensic medicine, highlighting its potential to reshape practices and contribute significantly to societal well-being.

Prevention of the spread of infection during highly infectious autopsy using acraniotomy box.

In cranial autopsies, the post-mortem examination requires the use of a saw for the removal of the skull cap. In these procedures, sawing of bone becomes a critical source of infectious aerosols which spread instantaneously in the immediate environment, generating liquid aerosols including droplets of cerebrospinal fluid and blood, and leading to exposure of all autopsy personnel. In high-risk cases like prion disease, tuberculosis, severe acute respiratory syndrome (SARS), COVID-19, etc. where the skull would require sawing, the prime concern is the saw operator's exposure to these pathogens. Therefore, the author suggests the use of an ingenious ergonomic semi-circular craniotomy box during skull cap and brain removal in the autopsy procedure to successfully prevent the contamination of the entire autopsy hall. A transparent acrylic plastic box has been customized, which is semi-circular in shape having three walls, one semi-circular dome without a floor, a front wall with adjustable zipper closure, and a hind wall with circular holes with sleeves made of 5-layer fabrics. The dome contains one outlet for a vacuum suction pipe on the side, two holes on each side of the dome with non-woven fabric arms for the saw operator, and assistants' arms for performing skull opening procedures. The use of this box allowed the author to prevent and limit the spread of the generation of infectious aerosols in the autopsy hall as the bone dust collected in the vacuum ensures the safety of autopsy surgeons.

External challenges for specialists dealing with forensic autopsies.

In addition to poor infrastructure, and human resource constraints, forensic medicine specialists in developing countries face many external challenges. We aimed to investigate the prevalence, type, and source of external challenges confronting them including sex, age, religion, deceased's place of residence and the number of accompanying relatives. This cross-sectional, observational study was conducted between August 2020 and July 2022 at the Mortuary of AIIMS, Bhubaneswar with the approval of the ethical committee. Of note, forensic medicine specialists faced external challenges in about one in five cases (20.5%). Most demands were to either minimise the autopsy procedure (n = 65) or to conduct the autopsy at inappropriate times (n = 58). The demands to minimise the autopsy procedure were significantly associated with the deceased's age (p = 0.046), religion (p = 0.010), socioeconomic class (p = 0.020) and manner of death (p = 0.019). Our study found that forensic medicine specialists in India face significant external challenges. Avoiding unnecessary complete autopsies, implementing night autopsies, and embracing minimally invasive autopsies are recommended to mitigate these challenges.

Importance of microbiology in autopsy procedure

The importance of bacterial cultures in autopsy has been controversial since Filippo Pacini and Robert Koch's early investigation into the etiology of cholera. Death-war and / or post-mortem invasion by the patient's native flora poses a problem with respect to post-mortem intervals, selection of anatomical location of cultures containing blood, CSF, and number of specimens required to be bought and collected in Microbial Laboratory for processing. Additionally, importance of postmortem virus research is significant. An increasingly important aspect of occupational safety is involved in handling of patient samples by laboratory staff. During the AIDS epidemic, regulatory bodies were urged to reconsider the importance of postmortem microbiological tests. This editorial is used to determine the exact cause of death without sacrificing the logistical and human resources of the Institute of Microbiology Practical sampling guidelines. The American University of Pathologists (CAP) are known to have developed a general checklist item for performing autopsy, but there are no specific guidelines, recommendations, or checklist items to address performance criteria for postmortem microbial culture studies. This review provides a brief historical perspective on autopsy microbiology, including a discussion of concerns about the postmortem spread of microorganisms, followed by a description of how to sample.

Anatomical variations of the sternum: sternal foramen and variant xiphoid morphology in dried adult human sternum in Ethiopia.

Background: The sternum exhibits unique anatomical variations with major clinical and forensic implications. This study is devoted to providing baseline epidemiological information about the sternal foramen and variant xiphoid morphology in Ethiopia. Two extremely interesting and unusual variations of the sternal foramen are also discussed. Methods: This observational study was carried out using dried adult human sternum obtained from skeletal remains samples brought for medicolegal examination over a period of 4 years. A total of 94 dried adult human sternums (66 males (70.2%) and 28 females (29.8%)) were obtained with an age range of 21 to 57 years and a mean age at death of 38.383 ± 11.3480 years. Dried human sternum specimens were morphologically examined, and morphometric parameters were recorded and photographed. Results: A sternal foramen was found in 18 specimens (19.1%); 17 were male and one was female. A single sternal foramen was observed in 83.3% (n=15/18) of the sternal bodies and 11.1% (n=2/18) of the xiphoid processes (both males). In addition, a double sternal foramen was observed in a single male specimen on the mesosternum and xiphoid process. The most common sternal foramen site was at the fifth costochondral junction level. The xiphoid process was present in 77 samples and ended as a single process in 83.1% (n=64/77) of samples. In 15.6% (n=12/77) of the samples, the xiphoid process was bifurcated and trifurcated in a single male (1.3%) specimen. Conclusions: The sternal foramen and variation in xiphoid morphology are common anatomical variations in Ethiopia. The findings of the current study highlight the necessity of strict precautionary measures during sternal procedures in this study population. In addition, such incidental findings during radiologic and autopsy procedures should be properly evaluated to avoid misdiagnosis and misinterpretation of such findings as traumatic or pathologic conditions.

The association between calreticulin and glucagon-like peptide-1 expressions with prognostic factors in high-grade gliomas.

The aim of this study is to present the expressions of Calreticulin (CALR) and Glucagon-like peptide-1 (GLP-1) in high-grade gliomas and to further show the relation between the levels of these molecules and Ki-67 index, presence of Isocitrate dehydrogenase (IDH)-1 mutation, and tumor grade. A total of 43 patients who underwent surgical resection due to high-grade gliomas (HGG) (grades III and IV) were included. The control group comprised 27 people who showed no gross pathology in the brain during the autopsy procedures. Adequately sized tumor samples were removed from each patient during surgery, and cerebral tissues were removed from the control subjects during the autopsy procedures. Each sample was stored at -80°C as rapidly as possible until the enzyme assay. Patients with high-grade gliomas showed significantly higher levels of CALR and significantly lower levels of GLP-1 when compared to control subjects (P = 0.001). CALR levels were significantly higher, GLP-1 levels were significantly lower in grade IV gliomas than those in grade III gliomas (P = 0.001). Gliomas with negative IDH-1 mutations had significantly higher CALR expressions and gliomas with positive IDH-1 mutations showed significantly higher GLP-1 expressions (P = 0.01). A positive correlation between Ki-67 and CALR and a negative correlation between Ki-67 and GLP-1 expressions were observed in grade IV gliomas (P = 0.001). Our results showed that higher CALR and lower GLP-1 expressions are found in HGGs compared to normal cerebral tissues.

Obsessive-Compulsive Personality Disorder and Death by Suicide

IntroductionThe risk of suicide may be elevated in the presence of personality pathology. Adults with Obsessive Compulsive Personality Disorder (OCPD) may be vulnerable to depression and suicidal thoughts.ObjectivesTo identify factors associated with suicide in cases of OCPD.MethodsPsychological autopsy procedures were used to gather detailed information about adults who died by suicide and natural causes. A total of 75 deceased adults were evaluated using psychological autopsy procedures. Family members were interviewed about a recently deceased adult, using structured diagnostic interviews (SCID and SIDP-IV). Diagnostic summaries, coroner’s reports and police records were reviewed by a psychiatrist, a psychologist, a social worker, and a neuroscientist until agreement was reached about final diagnosis. The final sample included 40 adults who met criteria for OCPD (18 had died by suicide; 20 had died by natural causes). An additional 40 cases were examined in which evidence of PD was absent (19 had died by suicide; 18 had died by natural causes).ResultsThe diagnosis of a Major Depressive Disorder was significantly more common in suicide completers with OCPD compared to suicide completers without OCPD (X2 = 6.74, p < .01) or cases of natural death with OCPD (X2 = 12.70, p < .001). Suicide completers with OCPD displayed many symptoms of depression, more often than suicide completers without OCPD or cases of natural death with OCPD (see Table 1). As compared to the cases of natural death, both groups of suicide completers were more likely to have previously attempted suicide prior to their final act (X2 = 8.52, p < .05). Table 1.Comparison of four groups using psychological autopsy procedures to identify the presence of diagnostic criteria for a Major Depressive Episode at the time of death.OCPD SuicideOCPD Natural DeathNo PD SuicideNo PD Natural DeathX2Sad mood82.4%36.8%78.9%50.0%11.38 **Sleep disturbance82.4%38.9%73.7%46.7%9.53 *Feelings of worthlessness60.0%38.9%84.2%17.6%17.49 ***Reduced concentration58.8%27.8%57.9%14.3%9.89 *Recurrent suicidal ideation88.2%26.3%78.9%0.0%35.57 ***Loss of pleasure82.4%38.9%73.7%40.0%10.80 **Psychomotor changes50.0%33.3%61.1%26.7%5.04Reduced energy64.7%44.4%63.2%33.3%4.12Change of appetite70.6%26.3%42.1%31.3%8.37 *Note:*= p < .05;**= p < .01;***= p < .001ConclusionsAdults with OCPD appear vulnerable to a Major Depressive episode, and the combination of MDD with OCPD creates a significant risk for death by suicide. It is important to appreciate the influence of personality disorder or depression and suicide risk.Disclosure of InterestNone Declared

Sudden Death Due to Undiagnosed Ludwig’s Angina: An Autopsy Case Report

Ludwig’s angina is a rapidly progressive and gangrenous cellulitis in the submandibular, sublingual spaces, and neck. It is characterized by an elevated tongue and laryngeal edema, resulting in airway compromise and, rarely, in sudden death. The most common cause is an odontogenic infection of a molar tooth. Infection can spread to the superior mediastinum and buccal area through anatomical structures. Herein, we report the sudden death of a 45-year-old male who was not diagnosed with Ludwig’s angina. He died in the emergency room 20 minutes after loss of consciousness. Intubation was impossible owing to severe laryngeal edema. The C-reactive protein level was 33.81 mg/dL. On autopsy, a diffuse light green abscess of the submandibular space was detected, along with severe edema of the epiglottis, aryepiglottic fold, and vocal cords. Subsequently, we confirmed that the airway obstruction was caused by Ludwig’s angina based on a literature review. In conclusion, this report emphasizes the need to identify the infection source and perform a detailed dissection according to the anatomical structure in the autopsy procedure for Ludwig’s angina.

Firefighter Suicide: A Theoretical Model for a Population Specific Behavioral Autopsy Program.

Some research suggests that firefighters are possibly at greater risk than other at-risk first responder/public service populations for suicidality (e.g., police, Veterans, active duty military non-deployed males; Martin et al., 2017; Stanley et al., 2015; Stanley et al., 2016). Behavioral autopsies have been utilized to elucidate the clinical picture of other at-risk populations; however, to date there is no proposed or applied model for a suicide behavior autopsy in fire personnel. Developing a standardized suicide behavior autopsy will allow for a comprehensive understanding of firefighters who die by suicide and highlight potential areas for intervention. The aim of this paper is to integrate best practices for autopsy procedures from other high-risk populations into a comprehensive theoretical model for a proposed behavioral health autopsy for firefighters. Our recommended protocol is presented along with relevant limitations, clinical implications, and recommendations for future research.

Impact of the COVID-19 pandemic on pathological autopsy practices in Japan.

During the coronavirus disease 2019 (COVID-19) pandemic, autopsies have provided valuable insights into the pathogenesis of COVID-19. The precise effect of this pandemic on autopsy procedures in Japan, especially in instances unrelated to COVID-19, has not yet been established. Therefore, we conducted a questionnaire survey from December 2020 to January 2021 regarding the status of pathological autopsy practices in Japan during the first year of the COVID-19 pandemic. The questionnaire was sent to 678 medical facilities with pathologists, of which 227 responded. In cases where a confirmed diagnosis of COVID-19 was not made at the time of autopsy, many facilities counted them as suspected COVID-19 cases if pneumonia was suspected clinically. At around half of the sites, autopsies were prohibited for suspected COVID-19 cases. In addition, the number of autopsies of non-COVID-19 cases during the pandemic period was also investigated, and a significant decrease was observed compared with the incidence in the pre-pandemic period. The COVID-19 pandemic has affected not only the autopsies of COVID-19 cases but also the entire practice of pathological autopsies. It is necessary to establish a system that supports the implementation of pathological autopsy practices during the pandemic of an emerging infectious disease.

Anatomy and morphology of iliolumbar ligament

PurposeTo address limited amount of available data and contradictory statements in published works 60 Iliolumbar ligaments extracted from 30 cadavers were examined to describe their insertions and morphology.MethodsThe ligaments were removed during the standard autopsy procedures with a use of an oscillating saw, a chisel and a scalpel. The specimens were photographed before the extraction and measured alongside their anterior margin. Next, they were preserved in formaldehyde, stripped of other soft tissues and then examined, photographed and described.ResultsThe mean length of the ligaments was 31.7 mm. 44 specimens were described as single-banded, 13 as double-banded and 3 as other. In 24 cases costal process of LV has been fixed to the iliac plate by short ligamentous bands. In 38 cases there was a thick fibrous membrane connected to the ligament. No legitimate insertions on LIV vertebra were observed.ConclusionsTypical iliolumbar ligament consists of a single ligamentous band. Most common variability of the ligament consist of two bands. In approximately 40% of cases the costal process of LV can be additionally stabilized to the iliac plate by short, strong ligamentous bands. In 63% of cases a connection between the iliolumbar ligament and a fibrous membrane placed in the frontal plane, superiorly to the ligament, has been observed. There seems to be no convincing proof of existence of the insertion of the iliolumbar ligament on the LIV vertebra.

Recommendations of the Polish Association of Neuropathologists on performing post-mortem examination of the brain and spinal cord.

Neuropathological central nervous system (CNS) post-mortem examination is a highly specialistic element of the autopsy procedure with methodological specificity. Herein we propose updated recommendations for CNS autopsy for pathologists and neuropathologists. The protocol includes the compendium of neuroanatomy with current nomenclature, consecutive steps of gross examination, as well as appropriate sampling algorithms in different clinical and pathological settings. The significance of pathoclinical cooperation in differential diagnosis is exposed. We believe it is essential to create and promote the guidelines to improve the quality of CNS post-mortem examination at the national level.