Biochemical Brain Markers in Excited Delirium Deaths

  • Deborah C. Mash

Over the past decade, increased attention has been paid to the sudden deaths of some highly agitated subjects held in police custody, which were restrained or incapacitated by CEWs. Medical examiners often have extreme difficulty in identifying the cause of death, but frequently drug intoxication is considered a contributing factor. The symptoms of excited delirium include bizarre and/or aggressive behavior, shouting, paranoia, panic, violence toward others, unexpected physical strength, and hyperthermia. Throughout the United States and Canada, these cases are frequently associated with cocaine or methamphetamine abuse. Acute exhaustive mania and sudden death presents with behavioral signs and symptoms that are the same as in cases of cocaine excited delirium. However, the forensic autopsies fail to demonstrate a history of illicit drug use or positive toxicologic basis for the diagnosis. The striking parallel in behavioral symptoms between the manner of sudden death involving unusual behavior in these individuals suggests that a genetic brain disorder may be the precipitating cause of delirium and death. While the precise cause and mechanism of lethality remains controversial, we have demonstrated that there are network-level changes in dopaminergic synaptic markers in brain that identify and help to confirm the occurrence of the excited delirium syndrome. Characterization of adaptive and maladaptive functional interactions among brain pathways is a critical step towards development of evidence-based biomarkers of excited delirium.


Dopamine Transporter Core Body Temperature Neuroleptic Malignant Syndrome Neurochemical Pathology Chronic Cocaine 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The author would like to acknowledge the expert technical assistance of Margaret Basile, M.S., Qinjie Ouyang, B.A., and John Pablo, Ph.D. The author is grateful to Charles Wetli, M.D., W. Lee Hearn, Ph.D. and A. James Ruttenber, M.D., Ph.D., for their long-standing collaboration, guidance and helpful discussions on the topic of in custody excited delirium deaths. Julie K. Staley, Ph.D. contributed to the characterization of dopaminergic synaptic markers in postmortem brains of cocaine abusers and to many of the original publications cited here. Charles P. Wetli, M.D. and Steven B. Karch, M.D. have contributed to the author's views on excited delirium and to the application of the research findings in postmortem brain to forensic biology. This work was supported by a USPHS grant from the National Institute on Drug Abuse (DA06627).


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© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Department of NeurologyMiller School of Medicine, University of MiamiMiami

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