Department of Pathology

Medical Center Blvd

Winston-Salem, NC 27157
Phone: (336) 716-4311
Fax: (336) 716-7595

MEDICOLEGAL AUTOPSY REPORT

Pathologist:
Resident:
Autopsy Assistant:
Service:
Admitted:
Expired:
Autopsied:
Reported:
Attending Physician:

Medical
Examiner:

J. L. McLemore, M.D., Pathology

Eric M. Vail

Patient Name::
Medical Record #:
DOB/Age::
Race/Gender:

KING, ALEXANDRA BROOKE

NCBH Path #:

A15-1836

1/18/1993 (Age: 22)

W/F

10/28/2015
11/6/2015
12/7/2015
John P. Stewart
Buncombe County Medical Examiner

FINAL AUTOPSY DIAGNOSIS

I. Indeterminate gunshot wound of the head, with exit
A. Entrance gunshot wound of right temporal scalp
B. Perforation of right and left cerebri
C. No bullet recovered at autopsy
D. Exit gunshot wound of left temporal scalp
E. Trajectory: right to left, slightly front to back
II. Blunt force injuries of back and extremities
A. Contusions of the back
B. Contusions and superficial lacerations of the sacrum
C. Contusions of the left arm and right leg
***Electronically Signed Out By:

J. L. McLemore, M.D., Pathology***

ts

Summary of Findings
The cause of death for this 22-year-old woman, Alexandra Brooke King, is a gunshot wound of the head.
According to initial investigative reports, the decedents body was found in the French Broad River, approximately 1- 1 1/2 weeks
after being reported missing. Another woman, the decedents significant other, had also been reported missing at this time. The
vehicle associated with the decedent was found partially within the water on the bank of the river with blood noted on the front
passenger side.
Autopsy findings revealed an indeterminate range gunshot wound of the right side of the head. The bullet went through the brain
and exited out the left side of the head. A few contusions were on the back, left arm, and right leg. Scrapes and superficial
lacerations were on the sacrum and may be secondary to scraping against objects while being pushed by the rivers current. A
possible patterned contusion was on the lower right back. Toxicologic analysis of postmortem blood detected a small amount of
ethanol of which some or all may be secondary to neoformation due to decomposition of the tissues and blood.

EXTERNAL EXAMINATION

KING, ALEXANDRA BROOKE

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KING, ALEXANDRA BROOKE

Body Weight:
Body Length:
BMI:

134 lb
70.5 in

Autopsy Report

A15-1836

Representatives for the Asheville Police Department are present

during the autopsy.
19

The body is received within a sealed body bag. The body is that of a
well-developed, slightly bloated with early decomposition, Caucasian
woman whose stated age is 22 years. Body identification includes
identification bracelets around the left wrist and left ankle. The facial
features are recognizable. Identification is confirmed by tattoos,
circumstances and antemortem and postmortem radiographs of the
head.
The body is received clothed in a mud-covered blue sports bra and
mud-covered anklet socks. A blue strap, used in the recovery of the
body, is around the torso. Personal effects accompanying the body
include two dark wooden ear gauges imprinted with anchors.
The body is cool to the touch. Rigor is absent. Livor mortis is indistinct.
The body is covered by dark green-brown, adherent mud. Early
decompositional changes include mild gaseous bloating of the soft
tissues of the face, neck, and chest. Marbling involves the posterior
arms and legs. Green discoloration involves the abdomen and back.
The scalp hair is black, wavy, and measures to 3 1/2 inches in length
over the crown. The color of the irides cannot be assessed due to
postmortem corneal clouding. The sclerae and conjunctivae are red.
The nose and ears are not unusual except for enlarged holes matching
the gauges within the earlobes. The lips and gums are pale. The teeth
are natural and in adequate condition with evident repair. The neck is
without masses and the larynx is in the midline.
The thorax is symmetrical. The breasts are well-developed, without
palpable masses. The abdomen is slightly protuberant due to gaseous
distension. The external genitalia are those of a normal adult woman,
without obvious injuries. The anus and back are unremarkable. The
upper and lower extremities are well developed and symmetrical,
without absence of digits.
Identifying marks and scars consist of a tattoo of a rainbow/checkmark
symbol and MATE on the anterior right wrist; a tattoo of a rainbow
colored lightning bolt within which is a tree pattern on the proximal to
distal posterior upper right arm; a tattoo of a symmetrical, mirror image
of 1/2 of an anchor on each foot; a 3/4 inch, blue-purple square of
possible ink on the distal anterior right ankle.
No evidence of emergency resuscitation and/or medical therapy is
present.
Evidence turned over to the representatives from the Asheville Police
Department during the autopsy includes a sports bra and socks; a
bloodspot card; pulled scalp hair; four vaginal swabs; the blue strap
around the body; and earlobe expanders.

EVIDENCE OF INJURY
HEAD AND NECK
GUNSHOT WOUND
On the lateral right temple, 3 1/2 inches below the top of the head, 36
1/2 inches above the inferior gluteal fold, and 5 inches right of the
anterior midline as measured along the curvature of the head, is a 3/16
inch, round defect with a less than 1/16 inch, circumferential, pink
marginal abrasion consistent with an entrance gunshot wound. No soot
or stippling is on the skin surrounding the entrance gunshot wound. The
KING, ALEXANDRA BROOKE

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Autopsy Report

A15-1836

wound track sequentially perforates the lateral right temporal bone,

producing a 3/8 inch, round defect with inward beveling; perforates the
right and left cerebri; perforates the lateral left temporal bone, producing
a 3/4 inch, triangular defect with outward beveling. Associated injuries
include diffuse hemorrhage of the right temporalis muscle and diffuse
red discoloration of the right face. Facial fractures involve the medial
orbital plates. On the lateral left temporal scalp, 3 1/2 inches below the
top of the head, 36 1/2 inches above the inferior gluteal fold, and 6
inches left of the anterior midline as measured along the curvature of the
head, is a 5/16 inch, irregular laceration without marginal abrasion,
consistent with an exit gunshot wound. No bullet is recovered at
autopsy. The trajectory is from the decedents right to left and slightly
front to back.
POSTMORTEM RADIOLOGIC STUDIES
X-rays of the head reveal no retained bullet. Dental restorations of the
lower molars and the assessment of the frontal sinus are used for
confirmation of identification.
CHEST AND ABDOMEN
A 1 x 3/4 inch, oval, purple contusion is on the upper lateral right back. A
3 x 2 inch area of purple contusions with centrally located,
near-confluent, vertical, superficial lacerations without associated
hemorrhage, is on the sacrum. An 8 x 5 inch area of diffusely scattered
round and near-confluent, red-purple contusions is on the lower medial
left back. A 1/2 x 1 inch, oval, light purple contusion is on the
posterolateral left hip. A similar light purple contusion is on the lower
medial right back. A possible patterned contusion consisting of a
4-sided, scalloped, purple contusion with 1/4 inch, laterally radiating,
horizontal, linear contusions at each divot of the scallop is on the lower
lateral right back.
UPPER EXTREMITIES
A 2 x 1 1/2 inch, irregular, dark purple contusion covers the left elbow. A
1/2 inch, oval, purple contusion is on the proximal posterior left forearm.
LOWER EXTREMITIES
A 1 1/2 x 1 inch, round, purple contusion is on the proximal to mid
posterior right lower leg.

INTERNAL EXAMINATION
BODY CAVITIES
Panniculus adiposus: 2.0 cm

CENTRAL NERVOUS SYSTEM

Brain weight: 1310 gm

KING, ALEXANDRA BROOKE

The right and left pleural cavities contain 200 mL and 100 mL of thin,
red, decompositional fluid, respectively. All body organs are present in
normal and anatomical position.

The dura mater and falx cerebri are intact except for the perforating
gunshot wound injuries. The leptomeninges are thin and delicate with
patchy subarachnoid hemorrhage. The cerebral hemispheres are
symmetrical. The structures at the base of the brain, including cranial
nerves and blood vessels, are intact and free of abnormality. Sections
through the cerebral hemispheres reveal no non-traumatic lesions within
the cortex, subcortical white matter, or deep parenchyma of either
hemisphere. The basal ganglia, thalami, and Ammon's horn are
unremarkable. The cerebral ventricles are normal caliber. Sections
through the brain stem and cerebellum are unremarkable.
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Autopsy Report

A15-1836

NECK
Examination of the soft tissues of the neck, including strap muscles and
large vessels, reveals no abnormalities. The hyoid bone and laryngeal
cartilages are intact. The lingual mucosa is intact; the underlying firm
red-brown musculature is devoid of hemorrhage.
CARDIOVASCULAR SYSTEM
Heart weight: 240 gm

RESPIRATORY SYSTEM
Right lung weight: 400 gm
Left lung weight: 310 gm

LIVER AND BILIARY SYSTEM

Liver weight: 1240 gm
Bile volume:
15 mL

The pericardial surfaces are smooth, glistening and unremarkable; the

pericardial sac is free of significant fluid or adhesions. The coronary
arteries arise normally, follow a right-dominant distribution, and are
widely patent, without significant atherosclerosis or thrombi. The
chambers and valves bear the usual size-position relationships and are
unremarkable. The myocardium is dark red-brown, soft, and
unremarkable; the atrial and ventricular septa are intact. The
thicknesses of the ventricular walls are: left ventricle (1.0 cm);
interventricular septum (0.9 cm); right ventricle (0.2 cm). The aorta and
its major branches arise normally, follow the usual course, and are
widely patent, free of significant atherosclerosis and other abnormality.
The vena cava and its major tributaries return to the heart in the usual
distribution and are free of thrombi.

The upper airway is clear of debris, foreign material, and significant fluid;
the mucosal surfaces are smooth, yellow-tan and unremarkable. The
pleural surfaces are smooth, glistening and unremarkable. Lobar
divisions are of the usual configuration. The pulmonary parenchyma is
dark purple, exuding moderate amounts of blood and frothy fluid; no
focal lesions are noted. The pulmonary arteries are normally developed,
patent, and without thrombus or embolus.

The hepatic capsule is smooth, glistening and intact, covering brown

parenchyma with no focal lesions noted. The gallbladder contains
yellow-green, slightly mucoid bile; the mucosa is velvety and
unremarkable. The extrahepatic biliary tree is patent, without calculi.
The portal vein and its tributaries are unremarkable.

ALIMENTARY TRACT
The esophagus is lined by gray-white, smooth mucosa. The gastric
mucosa has postmortem loss of the usual rugal folds, and the lumen
has 140 mL of thin, green-brown liquid with white, partially digested
material suggestive of potato. The serosa of the small and large bowel is
unremarkable. The appendix is present. The pancreas has a normal
gray-white, lobulated appearance and the ducts are unobstructed.
GENITOURINARY TRACT
Right kidney: 100 gm
Left kidney: 130 gm
Urine volume: < 1 mL

The renal capsules are smooth and thin, semi-transparent, and strip with
ease from the underlying smooth, dark brown cortical surfaces. The
cortex is sharply delineated from the medullary pyramids, which are
purple and unremarkable. The calyces, pelves, and ureters are
unremarkable. The relationships at the trigone are unremarkable. The
mucosa of the urinary bladder is gray-tan and smooth. The uterus,
fallopian tubes, ovaries and vagina are unremarkable. The endometrium
is 0.1 cm thick and red. The breast tissue has the usual fibrous and
adipose mixture.

RETICULOENDOTHELIAL SYSTEM
Spleen weight: 180 gm
The spleen has a smooth, intact capsule covering dark purple, soft
parenchyma; the lymphoid follicles are indistinct. The regional lymph
nodes appear normal. The bone marrow is red-purple and
homogeneous, without focal abnormality.
ENDOCRINE SYSTEM
The pituitary, thyroid, and adrenal glands are unremarkable.
KING, ALEXANDRA BROOKE

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KING, ALEXANDRA BROOKE

Autopsy Report

A15-1836

MUSCULOSKELETAL SYSTEM
Except as noted in the "Evidence of Injury" section, the remaining bony
framework, supporting musculature, and soft tissues are not unusual.

Block Summary
Heart, brain
Spleen, lungs
Liver, pancreas, kidney
Microscopic Description
1.
2.
3.

HEART- Sections show normally arranged myocytes. Intravascular bacterial overgrowth is present.
LUNGS- Sections show postmortem breakdown and peribronchiolar brown pigment-laden macrophage clusters.
All other tissue sections show postmortem breakdown but no significant histopathology.

TOXICOLOGY
Toxicology Folder:
Date of Report:

T201509160
16-nov-2015

DECEDENT: Alexander Brooke King

Status of Report: Approved
Report Electronically Approved By: Justin Brower, PhD
===============================================================================
SPECIMENS received from Jerri L. McLemore on 12-nov-2015
S150025633: 4.0 ml Blood
SOURCE: Aorta

CONDITION: Postmortem
OBTAINED: 06-nov-2015

Ethanol ---------------------------------- 30
mg/dL
11/16/2015
_______________________________________________________________________________
S150025634: 5.0 ml Blood
SOURCE: Iliac vein

CONDITION: Postmortem
OBTAINED: 06-nov-2015

_______________________________________________________________________________
S150025635:
SOURCE: Liver

Liver

CONDITION: Postmortem
OBTAINED: 06-nov-2015

_______________________________________________________________________________
S150025636: 1.0 ml Bile
SOURCE: Gall Bladder

CONDITION: Postmortem
OBTAINED: 06-nov-2015

_______________________________________________________________________________
S150025637:
SOURCE: Muscle

Muscle

CONDITION: Postmortem
OBTAINED: 06-nov-2015

Anatomic source is left thigh

_______________________________________________________________________________
KING, ALEXANDRA BROOKE

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KING, ALEXANDRA BROOKE

S150025638:
SOURCE: Brain

Autopsy Report

Brain

A15-1836

CONDITION: Postmortem
OBTAINED: 06-nov-2015

_______________________________________________________________________________
Accredited by the American Board of Forensic Toxicology, Inc.
111615 16:03

*** END

OF

REPORT ***

COPY TO:
John P. Stewart, MD

KING, ALEXANDRA BROOKE

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