Friday, June 3, 2011

The Benoit autopsy

Chris Benoit



     The article Chronic traumatic encephalopathy in a professional American wrestler was published in the Journal of Forensic Nursing in 2010. (1) The lead author is Bennet Omalu, M.D., professor of pathology in the Department of Pathology at the University of California, Davis.  He is also a founding member of the Brain injury Research Institute.  He is credited with being the first to describe the physical findings of chronic traumatic encephalopathy. (2) 

     The article describes the autopsy results of Chris Benoit.  The most important findings with interpretation are as follows:
                                                                                                                                     

Cause of death: asphyxiation due to hanging. 

Benoit chocked to death by hanging.  At autopsy there was a tight looped rope ligature around the neck.  Underneath the rope ligature was a white towel wrapped around the neck.  The ligature indentation was 0.6 to 1.3 cm in width circumferentially situated around the neck.  Internally there were no fractures to the hyoid bone or thyroid cartilage.

Manner of death: suicide.

There was cardiomegaly (620 g) with bilateral atrioventricular dilatation.
 

The findings describe an enlarged heart (cardiomyopathy).  The findings are suspicious for androgenic anabolic steroid (AAS) use.  The average adult human male heart weighs about 300 g.  Use of AAS can cause an abnormal enlargement of the heart. (3, 4) 
 
Liver weighed 2,620 g and the spleen weighed 300 g.
 

The findings describe an enlarged liver (hepatomegaly) and an enlarged spleen (splenomegaly).  In a healthy adult the liver weighs about 1,500 g and the spleen about 170 g.  The findings suggest the use of performance enhancing drugs.  AAS have been associated with hepatomegaly.  (5)   However, when multiple organs are enlarged the possibility of human growth hormone (HGH) use needs to be considered.

HGH has been used by athletes.  Benoit was linked to the Signature Pharmacy drug ring which sold AAS/HGH to a number of professional wrestlers. (6)  The side effects of HGH use have not been well studied. (7)  What little information is available in the medical literature pertains to the use of HGH in adults deficient of the hormone.  Reported side effects of HGH administration include peripheral edema, carpal tunnel syndrome, impaired glucose levels, and arthralgias. (8)   If given at high enough doses, HGH would be expected to cause acromegaly.  This condition has been associated with organ enlargement.  Definite acromegaly however has not been reported in any athletes using HGH.  

The testes appeared grossly normal, but microscopic examination showed atrophy of the seminiferous tubules with arrest of germ cell maturation. 

The microscopic findings are consistent with AAS use.  AAS administration has a number of effects on the male reproductive system including declines in sperm density, sperm count, and sperm motility.  The use of AAS can produce an infertility state that typically resolves upon cessation of drug use. (9)


The brain appeared grossly normal, but microscopic and immunohistochemical findings showed there were mild to moderate neocortical neuronal dropout and diffuse cerebral taupathy. 


There was evidence of abnormal accumulation of tau protein.  Tau is normally present in the cells of the nervous system.  It is responsible for binding microtubules, which play a role in the maintenance of cell shape and function.  An abnormal accumulation of tau protein may follow chronic traumatic brain injury. (1)  This may in turn impair normal nervous system functioning and give rise to the symptoms seen with chronic traumatic encephalopathy which may include cognitive, intellectual, and psychiatric problems. (10)  An abnormality with the tau protein has been observed in other neurodegenerative disorders such as Alzheimer's Disease, Progressive supranuclear palsy, and Frontotemporal dementia.

Alprazolam (50 ug/L) and Hydrocodone (45 ug/L) were present.
 


Alprazolam is a type of benzodiazepine.  It is approved for treatment of anxiety, anxiety with depression, and panic disorder.  

Hydrocodone is an opiate used for analgesia. It is usually sold in combination with another drug such as acetominophen and known by brand names such as Vicodin and Lortab.



An elevated Testosterone (207 ug/L) and Testosterone to Epi-testosterone (59) were present.
 

There are a number of factors that can influence the testosterone level in a male.  The "normal" range is often defined as 3.5-12 ug/L.  

Epitestosterone is a naturally occurring steroid that differs slightly is structure from testosterone.  In a healthy male the ratio of testosterone to epitestosterone is 1:1.  While normal ratios up to 4:1 and even 10:1 can occur, ratios greater than 1:1 are always suspicious for the use of exogenous testosterone.

It is known that Benoit's personal physician Dr. Phillippe Astin was accused of prescribing a 10 month supply (specific quantity not reported) of testosterone every 3 to 4 weeks from May 4, 2006 to May 9, 2007. (11)







    References:

    1.   J Forensic Nurs 2010; 6: 130.
    2.   www.braininjuryresearchinstitiute.org.
    3.   Physician Sportsmed 1988; 16(11): 109.
    4.   Med J Aust 1993; 158: 34.
    5.   J Forensic Sci 1990; 35(6): 1441.
    6.   http://sportsillustrated.cnn.com/2007/more/08/30/wrestlers/
    7.   Ann Intern Med 2008; 148: 747.
    8.   Clin Endocrinol 1995; 43(2): 143.
    9.   Sports Med 2002; 32(5): 285.
    10.   J Forensic Nurs 2010; 6(1): 128.  
    11.   http://sports.espn.go.com/espn/news/story?id=2973334


    Photographs are for illustrative purposes only.  Wrestling with Death does not claim ownership.

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