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Part of the following may have been sent last night. The following is the complete text with additions and corrections. Again condolences on Joe's death. It is clearly a tragedy regardless of the cause and even more so if medical personnel played a role in it. I will try and translate for you. This is more of a translation than a comment but I have added some comments where appropriate. Joe was only 57, and the coroner's report says he appeared "younger than recorded 57 years." > He was healthy in every respect except for his Parkinsons, which had > forced him to leave his job a few months earlier. He had taken part in a > test of Mirapex, one of the new drugs which came on the market later, and > had been on Amantadine, Tasmar and Requip, at different times, shortly > before his death. > He had suffered periods of severe dystonia and hallucinations > immediately prior to his hospitalization, and had been sent to a psychiatric > ward after an emergency admission. > We (Joe's friends) had suspected that the number of different drugs Joe > had been given, and possibly the amounts, contributed to his death, and we > now feel the official reports confirm this. I am not so sure. The emboli seem to be the cause of death but I don't see a cause or a source for them. (Emboli can be fat, blood clots, air etc. and can come from a number of sources a broken bone can cause marrow emboli. Emboli from blood clots can come from the atrium of the heart when one is in atrial fibrillation. They can come from phlebitis but in general they shower the lungs before getting to the brain. > The medical jargon may be difficult for most of us to interpret, but > here, in a nutshell, is what the coroner's report said: > There is no evidence of diffuse Lewy body disease in addition to > Parkinsons. > "There was evidence of relatively recent infarcts in multiple > territories of the brain, suggesting embolism. These lesions, perhaps in > conjunction with drugs he may have been taking for his Parkinson's disease, > may constitute the structural basis for the hallucinations." This finding can certainly be the cause of death. An embolism at the right place can certainly cause it. In other locations it might conceivably be the cause of the hallucinations too. > That may explain the hallucinations, but does not say what killed Joe. > In his post mortem report, the coroner says: "An anatomical cause of > death has not been demonstrated," but the official cause of death is "apneic > seizure" and "by what means": "natural." I think they are saying here in layman's terms that he stopped breathing. Not that he had a classical seizure but I am not entirely certain > > Apparently to explain the cause of the seizures, a Neuropathy Report > says: "Some infarcts are present in the CA-1 sector of the hippocampus and > in the white matter of the frontal lobe. The infarct on the hippocampus can > be dated since it shows complete loss of neurons, accompanied by prominent > microglial proliferation and gliosis, without cavitation. Thus, this infarct > must be more than a week old, but less than at most a few months of age." This is the microscopic exam confirming the infarcts. (the death of tissue due to an interruption of blood supply). It shows (I presume) that the infarct is 1 week to several months of age and in this phrase they are explaining the histologic findings that make them draw this conclusion. > (If anybody can clarify this in laymen's terms, we'd be happy to hear > from you.) > Privately, the coroner describes the cause of death as "emboli in the > brain." They don't give the origin of the emboli. That would be important. > > An interesting, although perhaps inconclusive, section of the reports > comes from the Centre of Forensic Sciences, and concerns Amantadine, one of > the drugs Joe was taking in the later stages: > "The detected level of Amantadine exceeds concentrations associated with the > therapeutic administration of the drug . . . Whereas central nervous system > toxicity including nervousness, confusion, hallucinations, seizures and > coma, has been associated with plasma concentrations of 0.1 to 0.5 mg/100 mL > . . ., fatalities attributed solely to Amantadine have been associated with > blood > concentrations of 2.1 mg/100 mL . . . . and greater." > Joe's Amantadine level was 1.3 mg/100 mL. (During the two days before > his death, Joe's Amantadine had been reduced significantly.) > We still don't know what combinations or levels of drugs caused him to > die, if indeed the drugs were the culprit. This is interesting. If he took too much amatadine (due to some confusion etc.) or he was accumulating it in his system through metabolic means it could account for his confusion but still doesn't answer the question of where the emboli came from that presumably killed him. Another possibility is that he took amatadine just prior to death giving a peak value rather than steady state. I think that the question of what killed Joe will always be up for question but the most likely cause is the emboli (of undetermined origin) as the Medical Examiner stated. I hope this is useful to you. Again my deepest sympathy. Please feel free to contact me for any further clarification etc. ******************************************************************************** Charles T. Meyer, M.D. Middleton (Madison), Wisconsin [log in to unmask] ******************************************************************************************