**4.2. Cerebral ischemia**

It is known that transient cerebral ischemia induces neuronal apoptosis (Chan, 2004); however, the usual feature of global ischemia involves neuronal necrosis in the cerebral cortex (watershed/arterial border zone of the frontal gyri), the globus pallidus, the hippocampus and the celebellar Purkinje cells. Immunohistochemistry detected no evident changes of the brain in sudden death due to acute heart attack (simple cerebral ischemia); however, prolonged deaths under intensive medical care, possibly involving reperfusion, showed higher parietal glial bFGF positivity and neuronal loss with low ssDNA positivity, indicating incomplete necrosis or selective neuronal necrosis without positive evidence of apoptosis (Table 3) (Wang et al., 2011a).


**Table 2.** Major causes of hypoxia and asphyxia in the forensic context
