Roger Thomas. F.R.C. Path.
Dr Angela Wilson,
HM Coroner,
Southwark.
26 June 2000
Dear Angela,
Following our recent telephone conversation, I write to summarise certain concerns which you might like to include as an addendum to my post-mortem report (PM2698/RT) on Ms Susan Carlish, a twenty-six-year-old stroke victim discovered at home on 15 June.
The PM was performed at St Thomas's Hospital on 17 June. The deceased died as a result of a brainstem infarction due to basilar artery occlusion from what would appear to be spontaneous vertebral artery dissection. Examination being twelve hours post mortem, I was unable to test for Protein C and Protein S deficiency. This aside, and taking into consideration that Ms Carlish was an occasional smoker, there would still appear to be an absence of conventional risk factors for stroke. I also discovered some minor neck trauma with ligamentous damage at C1 and C2 vertebral level though this would not be inconsistent with some previous whiplash or sporting injury. Traces of a benzodiazepine were discovered in the blood. Enquiries have produced a prescription for Valium made out to Ms Carlish's flatmate eighteen months ago.
While I remain in no doubt as to the cause of death, and concede that all police enquiries have drawn a blank, I am consulting a number of colleagues and copying this letter to all pathology departments and Coroners Courts in the Greater London area. I would be interested to confer with anyone who may have dealt with the body of a stroke victim (prob. female 20–30) displaying any or all of the following peculiarities:
Absence of conventional risk factors
Torn ligaments in neck
Benzodiazepines in the bloodstream
If you wish to discuss my findings, with a view perhaps to a second post-mortem examination, I would of course be delighted to chat with you further.
Yours sincerely,
Dr Roger Thomas FRC Path, Consultant Pathologist
P.S. The condition of the body (which honked like a pair of freshly scrubbed wellies!), was as I told you, of no concern to the authorities and delighted the morticians, but it was, to say the least, a little disconcerting!!
