Head injury vs. strangulation ***WARNING! AUTOPSY PHOTOS!***

Anti-K said:

I don’t recall hearing Kolar discuss Rorke. I only know what he wrote in his book.

According to Kolar (p. 64), Rorke said:
“The presence of cerebral edema, swelling of the brain, suggested that JonBenet had survived for some period of time after receiving the blow to her head. Blood from the injury slowly began to fill the cavity of the skull and began to build up pressure on her brain. As pressure increased, swelling was causing the medulla of the brain to push through the foramen magnum, the narrow opening at the base of the skull.”

There is nothing in the autopsy report to support the claim that the brain was pushed, or being pushed “through the foramen magnum.” Twenty or however-many hours between death and autopsy wouldn’t remove the evidence of this.

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Anti-K said:

There is nothing in the autopsy report that supports a claim of anything but MILD swelling of the brain: “The 1450 gm brain has a normal overall architecture. Mild narrowing of the sulci and flattening of the gyri are seen.”

The AR states a minimal amount of blood, and the any pressure that that minimal amount would have had – as it filled the cavity of the skull – would/should have been relieved by the hole in her skull. So, none of what Kolar has Rorke saying is supported by the autopsy. In fact, the autopsy seems to contradict Rorke (as according to Kolar).

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Anti-K said:

To me, as told by Kolar, it sounds like Rorke was describing what generally happens in such cases and not what happened in this specific case. Possibly, the real problem here is not Rorke’s “opinion,” but it is Kolar.
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AK

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otg said:

I’ve been meaning for a long time to tackle the subject of Dr. Rorke’s estimate, but just hadn’t found (or taken) the time. Mama, your question points out one more reason to doubt the time estimate that has gained so much general acceptance since it was reported by Kolar. TMK, until he wrote about the time estimate given by Dr. Lucy Rorke (-Adams), most other pathologists had all placed a much smaller time frame between the two. In fact, there was even disagreement between some as to which of the two insults came first. Those “experts” who thought the strangulation came before the head blow (most prominent among them was Dr. Wecht) usually cited the “small amount of brain swelling” or the lack of more bleeding as the basis for their opinion. So the question should be (IMO) why put so much credence in this one expert’s opinion over all others. After all, hers is very different from most of the other opinions. And if it is correct, it completely changes the circumstances that must have happened in order for there to be that long of an interval between the head blow and the strangulation.

I struggled with this “revelation” for a long time trying to reconcile the implications. Finally, after looking into the variables that should be considered, I found enough reason to justify questioning its validity. I might be accused of trying to fit the evidence to my theory of what happened. That’s a fair enough accusation, but in this case that “evidence” is only the opinion of one person. The real reason for questioning this is because it is so contrary to everything else that we know (including the opinions of nearly all other experts who have checked in on the subject), and because (like the pineapple) it is so critical to determining the sequence of events that led to JonBenet’s death.

Something important to consider in trying to decide which expert’s opinion might be more accurate than another’s is what information he/she had available to them at the time. At a minimum, the expert might have had only the AR on which to base an opinion. (There are some opinions which are still even today circulated that were based on the partial AR that was released before a judge ordered it released in full.) The most information a person could have would be to actually see the evidence firsthand and to have access to the results of any further testing that might be done (chemical, biological, microscopic, etc.). TMK, Dr. Meyer is the only pathologist who had all that. But he is not a neurological pathologist, and his conclusions and opinions have never been made public. Somewhere between those minimum and maximum amounts of information are a few “experts” like Dr. Rorke who (according to my information) was given access to lab reports, copies of microscopic slides, and even a section of the brain taken and preserved by someone in the ME’s office (more on that in another post). Additionally, Rorke is a neuropathologist -- an expert on brain pathology. Her credentials in this field are unquestioned. But her specialty is limited to this area and her knowledge in other areas important to consider might be limited.

Let’s look first at what Meyer said in the AR about the amount of swelling in the brain. I’ll try to give as much information as I have on this one part of the time estimate, and then I’ll write about necrosis -- the other factor reportedly looked at by Dr. Rorke in trying to estimate this time frame. The AR is supposed to be an objective account of what is seen by the medical examiner. But a noted observation can be misleadingly assumed to be an impartial conclusion. For instance, Meyer noted the following information:

The 1450 gm brain has a normal overall architecture. Mild narrowing of the sulci and flattening of the gyri are seen. No inflammation is identified.
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A “normal overall architecture” is a subjective description. So too is “mild narrowing”. But they’re important in knowing that Meyer made a general observation that there was not very much swelling of the brain. But in that same passage he notes that the brain weighed 1450 gm. For comparison on brain weights from another post (http://www.websleuths.com/forums/sh...ll-Fractures-The-Weapon&p=9054790#post9054790):

Weight of the Human Brain:
The average normal mass of an adult male human brain is approximately 1300 to 1400 grams (2.87 to 3.1 pounds).
The average Male's brain weighs 1360 grams (3 pounds)
The average Female's brain weighs 1250 grams (2.8 pounds)
A newborn human brain is about 350 to 400 grams (0.77 to 0.88 pounds).
A human’s brain grows quickly in the first years and reaches its full size by around the age of six.

The brain weights of some well known people:
The brain of Albert Einstein weighed a mere 1230 grams (2.71 pounds)
The brain of the German mathematician Carl Friedrich Gauss weighed 1492 grams (3.29 pounds)
The brain of the leading poet of the Russian Revolution Vladimir Vladimirovich Mayakovsky weighed a whopping 1700 grams (3.75 pounds)
​

Here are two charts showing average brain weights by age (one is by weight alone, while the other shows it as a ratio to body weight). I’ve added a green line showing where a 6 yo female should be on the scale and a red line to indicate JonBenet’s brain weight as measured during autopsy:

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Depending on the way it is compared, JonBenet’s brain at death weighed from 15 to 25 % more than normal for her age -- hardly what most people would call mild swelling of the brain, and an objective measurement of the extent of edema.

Here is an illustration showing several of the different signs of swelling in a brain (because of copyrights, I should mention it was taken from Knight’s Forensic Pathology by Pekka J. Saukko and Bernard Knight):

View attachment 58347

Something important the AR does not tell us is whether the swelling is local, diffuse half-brain, or diffuse whole-brain. This combined with an objective measurement of the extent of edema would be an indication of how long the edema had been allowed to progress throughout the brain after the initial injury.

But what causes cerebral edema? It’s not simply blood engorgement alone as some might think. Excess blood is only one component of the edema. Most of the swelling occurs from fluid buildup intracellularly as well as extracellularly (inside cells and in the spaces between the cells). One way this fluid can be seen microscopically is in the spaces surrounding and within the brain cells (both neuronal and neuroglial). This is possibly the reason for Meyer’s notation about the “clear halos” seen surrounding these cells (although there can be other reasons for this phenomenon). Additionally, as the swelling increases, it constricts the brain vasculature, slowing and then potentially shutting off blood flow from the brain. As the constricted blood continues building up in the brain, it and the other fluids become “self-potentiating” in that their excess continues to contribute to more swelling. The ICP (intracranial pressure) exponentially rises -- perpetuating itself and causing additional bleeding within the skull from any ruptured or open blood vessels.

Swelling on any external surface of the body (an injured ankle, wrist, etc.) is not limited as it is within the skull where there is little room to allow expansion of the brain other than through the foramen magnum at the base of the skull. That’s why, as a brain swells, it begins altering the appearance of the outside ridges of the brain -- the gyri and sulci. When there is no room left within this small space, the brain begins pressing at the base of the skull through the only opening -- the foramen magnum in the posterior cranial fossa. This is the opening through which the brain stem goes between the brain and the spinal column. When this stage of edema is reached, the tonsils of the cerebellum are impacted to the point that they become cone-shaped going into the foramen magnum. I’ve read about this effect, and I’ve seen pictures of normal versus impacted brains. The difference is very subtle and usually hard to notice without careful study. Unless a medical examiner is actually looking for this herniation because of other signs of edema, it might easily go unnoticed. Discoloration of the coned area is another sign, as well as necrosis of the impacted brain tissue.

It’s important to note here that in children, cerebral edema is more likely, more pronounced, and more quickly occurring than in an adult with the same injury. Also, edema in the brain can be caused from (or worsened by) hypoxia (ischemic hypoxia can be caused by strangulation). IOW, (and this is very important) strangulation increases brain swelling beyond what would be expected simply from a TBI (traumatic brain injury) alone.

Most of all this information I’ve written about here is not information we have available to us about the conditions of JonBenet’s brain. We know simply what little was written in the AR. It is therefore difficult trying to second-guess the opinion of a pathologist who has seen evidence we haven’t; and I don’t doubt that Dr. Rorke is as qualified as any other neuropathologist to estimate the length of time between a head injury and the death of a victim. But even with all the knowledge she or anyone else might have, there are limits to how accurate any estimate can be. I’ve written here about just some of the variables that can affect an estimate. Did she take into account the fact that a child’s cerebral edema develops much faster than an adult’s? Did she consider only how long it would take for the brain injury to develop separately to the point it did before the cord was wrapped around her neck ending her life? Or did she even consider the effect that strangulation would have on brain swelling if it was being applied at the same time as the blunt force trauma? I don’t doubt her expertise in the field of brain trauma, but how much does she know about the effects of strangulation? What were the assumptions she made (and she had to make assumptions) when arriving at her estimate? All we know is that resulting 45 to 120 minute timeframe she gave authorities. In one interview, Kolar mentions that she had also considered the digested pineapple in arriving at her opinion -- in addition to the cerebral edema and the necrosis of brain tissue.

But back to the original question: “If the head blow was inflicted prior to (45 minutes-2 hours, according to Kolar?) strangulation, then why was there ‘no evidence of inflammatory infiltrate or organization of the hemorrhage’?” Perhaps the simple answer to that question is that the supposition of 45 minutes to 2 hours is incorrect. In my opinion those things should have manifest themselves within a much shorter timeframe. Between the three conflicting injury responses (edema, inflammatory infiltrate, and organization of the hemorrhage), I believe the edema to be the least accurate measurement because of all the variables affecting it. But there are also other problems with that longer timeframe that I’ll try to address in another post.

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Some of this information comes from another post I wrote at FFJ which has additional information on causes and types of cerebral edema. That post is here:
http://www.forumsforjustice.org/for...kull-Fractures-The-Weapon&p=194988#post194988

Another post that addresses blood flow to the brain and some of the statements by Dr. Wecht:
http://www.websleuths.com/forums/showthread.php?7469-John-Ramsey-s-Role/page8&p=9570391#post9570391

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midwest mama said:

So the head bash, followed approximately how soon with the strangulation, according to a respectful educated opinion? Anyone, everyone?

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aussiesheila2 said:

Otg,

I don't know why you believe this rot about what Dr Lucy Rorke is supposed to have said about the bleeding in JonBenet’s brain.

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Prior to the release of Kolar’s book we had never heard mention of her. That should make you suspicious for a start. Kolar’s book doesn’t even have direct quotes from her, just an introduction by him that “she told investigators…”.

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He then follows this up with words supposedly from the lips of Dr Rorke “As pressure increased, swelling was causing the medulla of the brain to push through the foramen magnum, the narrow opening at the base of the skull.” Well knock me down with a feather, the coroner made absolutely no mention of this whatsoever in the autopsy report! Surely this should lead you to think that maybe, just maybe this didn't happen with JonBenet's brain. Do you really believe that if the brain was indeed protruding through the foramen magnum or even just pressing on it, the coroner would overlook that, something of such monumental significance? OMG.

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I don't believe Rorke was ever consulted by BPD of if she was she was just asked general questions about what happens when there is an injury that bleeds into the brain cavity. And if I were her, I would be suing Kolar’s book publisher for using my name and making me look so stupid.

Rorke's supposed statements about the condition of JonBenet’s brain are so at odds with the statements by coroner who examined her brain at the autopsy it is clear that if she did indeed make those statements they were not about the condition of JonBenet’s brain. Pity Kolar’s medical knowledge is so limited or he would have picked up on this.

Kolar is a nice bloke and obviously believes everything BPD tells him but what he wrote about Dr Rorke’s analysis is rubbish.


This is just yet more misinformation being peddled to the public by BPD.

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otg said:

I don’t know if you could have misunderstood what I wrote any more than you did, aussiesheila. I don’t believe, and I have never accepted, the extended time frame attributed to Dr. Rorke. You can look back on any of my posts since Kolar’s book was released and see that I always had doubts about it. But I didn’t simply dismiss it without looking into the reasons that she is supposed to have had for coming to her conclusions. After looking into it, I came to the opinion that she was most likely wrong. I’m simply sharing what I learned in coming to that opinion so that we can each make up our own minds. I can’t say that I have definite proof that she is wrong. But I certainly see plenty of reason to doubt it.


That’s right! And I was. All the more reason to question her reported time frame.



Well, here’s the thing about that... Dr. Meyer was a pathologist in a relatively small town. I doubt he did many autopsies where cerebral edema was an important issue. In my post, I pointed out the following: “The difference is very subtle and usually hard to notice without careful study. Unless a medical examiner is actually looking for this herniation because of other signs of edema, it might easily go unnoticed.” Normally the cerebellum and parts of the brainstem sit in an indented space at the lower part of the skull above the foramen magnum. This opening in the floor of the skull is funnel-shaped and leads to the spinal canal. When edema is enough to cause herniation of the cerebellar tonsils, it’s not as remarkable as one might expect. The ME won’t see how tightly the lower section of the brain actually sits in the skull or how much is pressing down into the foramen where this herniation occurs. That’s because after the top of the skull is cut away, the brain is pulled up so the spinal cord can be cut as far down as the knife can reach into the foramen magnum. Obviously, this is done by feel (without sight) because the brain is still sitting in the calvarium blocking the ME’s view of the base of the brain. After weighing the removed brain, it is then examined. Any evidence of herniation has to be what is observed remaining on the surface of the brain itself (or what might show up microscopically). Here is what is written in Knight’s Forensic Pathology:

The pathologist must be careful not to mistake the normal anatomical grooving that often exists around the cerebellar tonsils for ‘coning’. There should be other signs of brain swelling and true tonsillar herniation will show discoloration or even necrosis of the ischaemic, trapped tissue.
​

Well, I’ll go so far as to say I disagree with the extended time frame attributed to Dr. Rorke. I have no reason to doubt that she was consulted by the BPD, but I have reservations about exactly what her conclusions were since we only have one source on it -- and that is second-hand. I’ll leave the editorial comment and the legal advice for Dr. Rorke to you or anyone else. I’m just trying to explain what she might have considered and why it is that I disagree with her.

Please go back and read my post again. I disagree with the conclusion attributed to Dr. Rorke. It has nothing to do with who is responsible for the head blow. The evidence is what it is regardless of who caused it -- RDI, IDI, or WDI -- so you don’t have to disagree with the evidence simply because you disagree with my theory of responsibility.

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otg said:

Rather than quote each poster who keeps repeating that there was “little bleeding in the brain” or a “small (or “minimal”) amount of blood”, I’m addressing this to anyone who is under that misconception:

There was a lot more blood present in her skull (in several different layers) than what most people seem to think. There was about as much blood present as the skull will allow before its swollen state slows down the bleeding. There isn’t that much “room” or “empty space” inside the skull to begin with. To allow for excess blood, the pressure inside the brain has to equalize with the pressure in the arteries. This is what happens when the skull is being inundated with blood and cerebrospinal fluid caused by trauma. Eventually the ICP (intracranial pressure) will overcome the blood pressure, slowing or stopping the blood flow. I know where this misconception of “minimal blood” came from -- it came from Dr. Wecht’s early pronouncement that there was only about one and a half teaspoons of blood. That is not entirely correct. Read the AR for yourself, or read the translation here (http://www.websleuths.com/forums/sh...ll-Fractures-The-Weapon&p=9054790#post9054790). That estimate of 7 to 8 cc (1-1/2 teaspoons) only accounts for one area of bleeding: the subdural hemorrhage. In addition to that “subdural hemorrhage”, there was also a “subarachnoid hemorrhage overlying the entire right cerebral hemisphere”, “an extensive linear area of purple contusion” which “measures 8 inches in length with a width of up to 1.75 inches” (a contusion is made up of blood that leaks from the blood vessels into the affected tissue), and the blood found initially outside of the skull after reflection of the scalp (“an extensive area of scalp hemorrhage along the right temporoparietal area extending from the orbital ridge, posteriorly all the way to the occipital area” which “encompasses an area measuring approximately 7x4 inches.”). In total, this is NOT a “small” or “minimal” amount of bleeding!

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aussiesheila2 said:

I don’t believe I misunderstood your post at all otg. Please go back and read my reply again.

However, I do apologise though for flying off the handle and going into a rant over your post. I am a very angry poster, I know.

I say again - I do not think that you should even be bothering to consider what has been put out by Kolar as being Dr Rorke’s comments on JonBenet’s brain hematoma. I say this not because I think Rorke was wrong or right but because I don’t believe the comments that Kolar attributes to her were ever made in relation JonBenet’s brain hematoma.

Here are Rorke’s comments again, as outlined in Kolars’ book and purported to relate specifically to JonBenet’s brain -

“She told investigators that the blow to the skull had immediately begun to hemorrhage, and it was not likely that she would have regained consciousness after receiving this injury. The blow to the head, if left untreated, would have been fatal.

The presence of cerebral edema, swelling of the brain, suggested that JonBenét had survived for some period of time after receiving the blow to her head. Blood from the injury slowly began to fill the cavity of the skull and began to build up pressure on her brain. As pressure increased, swelling was causing the medulla of the brain to push through the foramen magnum, the narrow opening at the base of the skull.

Dr. Rorke estimated that it would have taken an hour or so for the cerebral edema to develop, but that this swelling had not yet caused JonBenét’s death. “Necrosis,” neurological changes to the brain cells, indicated a period of survival after the blow that could have ranged from between forty-five (45) minutes and two (2) hours.

As pressure in her skull increased, JonBenét was beginning to experience the effects of “brain death.” Her neurological and biological systems were beginning to shut down, and she may have been exhibiting signs of cheyne-stokes breathing.”​

I think Rorke’s comments were made in relation to brain hematoma in general. I think BPD are pretending that she made these comments specifically about JonBenet’s brain.

I think what Rorke was describing was what happens when a brain hematoma is the only cause of death, which happens far more frequently than what happened to poor JonBenet. The situation with JonBenet was unusual in that strangulation was also involved in her death and that was clearly not what had happened to the brains Dr Rorke was describing.

I think it I absurd for you to throw into question Dr Meyer’s assessment of the condition of the brain. The man was a medically trained and qualified forensic pathologist with 10 years' experience. So what if he hadn’t specialized in neuro-pathology. This stuff he was describing is just so basic and fundamental, any half intelligent first year physiology student understands and grasps it. It certainly isn’t the sort of thing a fully qualified and experienced medico is going to get confused over. Meyer would not have been confused about any of this stuff, just as Dr Rorke would not have either. The reason their observations are so different is because they were talking about two entirely different situations. Meyer’s are relevant to the case, Rorke’s are not.

You have definitely misunderstood my post too otg. My main point was that I don’t believe Dr Rorke ever spoke to BPD specifically about JonBenet’s head injuries. If she did speak to them about head injuries, and she may well have, then she was clearly speaking only in general terms and not JonBenet’s head injury specifically. I believe I stated this in my earlier post but perhaps not clearly enough. I just don’t understand why you wasted your time considering what has been put forth as Dr Rorke’s conclusions about JonBenet’s head injury. It is so obvious they weren’t her conclusions about JonBenet’s head injury at all. This is just what BPD wants you to believe but they are deceiving you IMO.

Sorry to have ranted again.

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Charterhouse said:

Also didn't Dr Meyer say that he did not include all the information in the AR but would talk about it if there was a trial. (Now I may have dreamed this because I can not find the source but I thought he said it) Anyone? Everyone?

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otg said:

I don’t know if you could have misunderstood what I wrote any more than you did, aussiesheila. I don’t believe, and I have never accepted, the extended time frame attributed to Dr. Rorke. You can look back on any of my posts since Kolar’s book was released and see that I always had doubts about it. But I didn’t simply dismiss it without looking into the reasons that she is supposed to have had for coming to her conclusions. After looking into it, I came to the opinion that she was most likely wrong. I’m simply sharing what I learned in coming to that opinion so that we can each make up our own minds. I can’t say that I have definite proof that she is wrong. But I certainly see plenty of reason to doubt it. ~RSBM~ The evidence is what it is regardless of who caused it -- RDI, IDI, or WDI -- so you don’t have to disagree with the evidence simply because you disagree with my theory of responsibility.

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Charterhouse said:

According to the JBR Case Encyclopedia even Dr.Meyer said that the time of death is not factual but interpretive. Since many of the tests were not done to determine the time of death I don't think we can really ever say when JB was killed.
I just can't base my opinion on who did it according to the timeline between the head bash and the strangulation. As you said UKGuy there are too many things that could account for the amount of blood. And as otg said the small amount of blood that was reported was only from one area of trauma. This case was really screwed up by so many people on so many levels.

Also didn't Dr Meyer say that he did not include all the information in the AR but would talk about it if there was a trial. (Now I may have dreamed this because I can not find the source but I thought he said it) Anyone? Everyone?

So I figure you have to just determine for yourself which experts if any you want to believe and how much of that information is correct. JMO

I hope this made some sense. I know I am talking about TOD and the bleeding but I don't know that they can be used together to determine who did what when. JMO

"Coroner's Note. A Note from Dr. John Meyer August 13, 1997 is posted at Webbsleuths (see bottom of page, following Autopsy Report). "Contrary to several media reports over the past few days, the autopsy report on JonBenet Ramsey does not and has never contained information on the estimated time of death. I have not been able to determine the original source of the statement that the report contained the estimated time of death, but it certainly did not come from this office. The time of an "unwitnessed" death is very difficult to determine with any precision, and at best is an estimate based not only on autopsy findings but also on investigative information. I consider estimation of time of death to be an interpretive finding rather than a factual statement, and it is not this Office's practice to include this estimate as part of any autopsy report. As has been stated in the past, it would also be inappropriate for me, as a potential expert and material witness, to make interpretive statements prior to testifying in court." John E. Meyer, M.D., Boulder County Coroner."

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As you said UKGuy there are too many things that could account for the amount of blood. And as otg said the small amount of blood that was reported was only from one area of trauma.

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The presence of cerebral edema, swelling of the brain, suggested that JonBenet had survived for some period of time after receiving the blow to her head. Blood from the injury slowly began to fill the cavity of the skull and began to build up pressure on her brain. As pressure increased, swelling was causing the medulla of the brain to push through the foramen magnum, the narrow opening at the base of the skull.

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Anti-K said:

The only thing that needs to be noted about the “minimal bleeding” is that there was less than would be expected if the victim had survived for any real length of time.
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AK

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Anti-K said:

I agree with you, aussiesheila2. I think Rorke’s comments were made in general, and not specific to Jonbenet.
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AK

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aussiesheila2 said:

Exactly

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The only thing that needs to be noted about the “minimal bleeding” is that there was less than would be expected if the victim had survived for any real length of time.

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Anti-K said:

I agree with you, aussiesheila2. I think Rorke’s comments were made in general, and not specific to Jonbenet.
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AK

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