(Reuters) - An Ohio coroner, abiding by family wishes, has performed an external examination instead of a full autopsy on the body of the U.S. student who was held prisoner in North Korea for 17 months and sent home in a coma, the agency said on Tuesday. 
 
 The Hamilton County Coroner’s Office was still conferring on Tuesday with doctors at a Cincinnati hospital who were treating Otto Warmbier, 22, before reaching any conclusions about his death a day earlier, investigator Daryl Zornes said. 
 
 Investigators also were continuing to review radiological images and awaiting additional medical records requested by the coroner, Zornes told Reuters. 
 
 He declined to estimate how long it would take for the coroner’s office to complete its inquiry. Preliminary autopsy findings had been expected later on Tuesday or on Wednesday. 
 
 There was no immediate word from the family about why relatives declined an autopsy, which may have shed more light on the cause of the neurological injuries that left him in a coma. 
 
 Warmbier’s death came just days after he was released by the North Korean government and returned to the United States suffering from what U.S. doctors described as extensive brain damage. 
 
 Warmbier, an Ohio native and student at the University of Virginia, was arrested in North Korea in January 2016 while visiting as a tourist. He was sentenced two months later to 15 years of hard labor for trying to steal an item bearing a propaganda slogan from his hotel in North Korea’s capital, Pyongyang, the nation’s state media said. 
 
 The circumstances of his detention and what medical treatment he received in North Korea remain unknown. The United States has demanded North Korea release three other U.S. citizens it holds in detention: missionary Kim Dong Chul and academics Tony Kim and Kim Hak Song. (Graphic of Americans held by North Korea: tmsnrt.rs/2pmE3ks) 
 
 Warmbier’s death has only heightened U.S.-North Korean tensions aggravated by dozens of North Korean missile launches and two nuclear bomb tests since last year in defiance of U.N. Security Council resolutions. The North Korean government has vowed to develop a nuclear-tipped intercontinental missile capable of hitting the U.S. mainland. 
 
 Warmbier’s family has not specified how he slipped from a comatose state to death, but said in a statement on Monday that the “awful torturous mistreatment” he endured while in captivity meant “no other outcome was possible.” 
 
 Relatives have said they were told by U.S. envoys that North Korean officials claimed Warmbier contracted botulism after his trial and lapsed into a coma after taking a sleeping pill. Fred Warmbier, the student’s father, has said he disbelieves this account. 
 
 North Korea’s government said it released Warmbier last week on “humanitarian grounds.” 
 
 U.S. President Donald Trump said on Tuesday he had spoken with Warmbier’s family and praised them as “incredible.” 
 
 “It’s a total disgrace what happened to Otto,” Trump told reporters in the White House, where he was meeting with Ukrainian President Petro Poroshenko. “And frankly, if he were brought home sooner, I think the results would have been a lot different.” 
 
 FILE PHOTO - Otto Frederick Warmbier, a University of Virginia student who has been detained in North Korea since early January, attends a news conference in Pyongyang, North Korea, in this photo released by Kyodo February 29, 2016. Mandatory credit REUTERS/Kyodo/File Photo 
 
 White House press secretary Sean Spicer said the administration would “continue to apply economic and political pressure” on North Korea, in conjunction with U.S. allies and China, “to change this behavior and this regime.” 
 
 Trump said on Twitter on Tuesday he appreciated efforts by Chinese President Xi Jinping “to help with North Korea,” adding “It has not worked out. At least I know China tried!” 
 
 The government of China, North Korea’s main ally, said Warmbier’s death was a tragedy. ||||| (Reuters) - An American student who had been imprisoned in North Korea for 17 months died from lack of oxygen and blood to the brain, an Ohio coroner said on Wednesday. 
 
 Otto Warmbier’s death on June 19 was due to an unknown injury that occurred more than a year before his death, Hamilton County Coroner Dr. Lakshmi Sammarco said at a news conference. 
 
 “We don’t know what happened to him and that’s the bottom line,” Sammarco said. 
 
 Warmbier’s parents could not be reached for comment on the coroner’s report. 
 
 The University of Virginia student was held by North Korea from January 2016 until his release on June 15. Warmbier, 22, was returned to the United States in a coma. 
 
 The coroner and a Sept. 11 report by her office cited complications of chronic deficiency of oxygen and blood supply to the brain in Warmbier’s death. Only an external examination of the body rather than a full autopsy was conducted at the request of Warmbier’s family. 
 
 North Korea had blamed botulism and the ingestion of a sleeping pill for Otto Warmbier’s problems and dismissed torture claims. 
 
 Warmbier died days after arriving back in the United States. 
 
 The native of Wyoming, Ohio, had been arrested at the airport in Pyongyang as he prepared to leave the reclusive communist country. He had been traveling with a tour group. 
 
 Warmbier was sentenced to 15 years of hard labor for trying to take from his hotel an item bearing a propaganda slogan, North Korea’s state media reported. 
 
 Saying his son had been tortured, Fred Warmbier told Fox News in an interview on Tuesday, “As we looked at him and tried to comfort him, it looked like someone had taken a pair of pliers and rearranged his bottom teeth.” 
 
 “Great interview on @foxandfriends with the parents of Otto Warmbier: 1994 - 2017. Otto was tortured beyond belief by North Korea,” President Donald Trump said on Twitter following the interview’s broadcast. 
 
 Slideshow (2 Images) 
 
 In response to a question at the news conference, the coroner said there was no evidence of trauma to Warmbier’s teeth nor was there evidence of broken bones. 
 
 The coroner’s report said that Warmbier’s body had multiple scars varying in size, including a large irregular one measuring 4.3 by 1.6 inches on the right foot. ||||| The parents of a University of Virginia student who was detained in North Korea for nearly a year and a half, then died just days after he returned home in a coma, lashed out at Pyongyang in their first television interview since their son’s death and called on North Korea to be listed as a state sponsor of terror. 
 
 Fred and Cindy Warmbier appeared Tuesday on “Fox & Friends,” saying they’d had time to do some healing in the three months since they buried their 22-year-old son, Otto. 
 
 “But now we see North Korea claiming to be a victim and that the world is picking on them, and we’re here to tell you: North Korea is not a victim,” Fred Warmbier said. “They’re terrorists. They kidnapped Otto. They tortured him. They intentionally injured him. They are not victims.” 
 
 Warmbier was arrested in January 2016 at the end of a brief tourist visit to the isolated country. This past June, he was medically evacuated and was being treated at the University of Cincinnati Medical Center when he died. 
 
 “Unfortunately, the awful torturous mistreatment our son received at the hands of the North Koreans ensured that no other outcome was possible beyond the sad one we experienced today,” the Warmbiers said in a written statement after his death. 
 
 North Korea denied that Warmbier had been tortured and tried to cast his death as a “mystery.” 
 
 [Otto Warmbier dies days after release from North Korean detention] 
 
 “The fact that Warmbier died suddenly in less than a week after his return to the U.S. in his normal state of health indicators is a mystery to us as well,” a North Korean Foreign Ministry spokesman was quoted by the official Korean Central News Agency in June. “To make it clear, we are the biggest victim of this incident.” 
 
 North Korea claimed Warmbier slipped into a coma after contracting botulism and taking a sleeping pill and that he was provided proper medical care. 
 
 On Tuesday, the Warmbiers vehemently pushed back against North Korea’s claims, sharing the utter shock and grief they felt meeting their comatose son at the airport. 
 
 “We walked over to the plane; the engines are still humming,” Fred Warmbier said. “When we got halfway up the steps, we heard this howling, involuntary, inhuman sound. We weren’t really certain what it was. … Otto was on the stretcher across in the plane, and he was jerking violently, making these inhuman sounds.” 
 
 Fred Warmbier on @foxandfriends: “North Korea is not a victim. They’re terrorist. They kidnapped Otto. They tortured him.” pic.twitter.com/NyzSMn0nIW — Fox News (@FoxNews) September 26, 2017 
 
 Fred Warmbier said his wife and daughter ran off the plane, while he and his other son walked over to the stretcher. Otto Warmbier now had a shaved head, a feeding tube emerging from his nose, and was blind and deaf. 
 
 “As we looked at him and tried to comfort him, it looked like someone had taken a pair of pliers and rearranged his bottom teeth,” Fred Warmbier said. 
 
 “They destroyed him,” Cindy Warmbier added, shaking her head. Within two days, their son’s fever spiked to 104 degrees; there was a large scar on his right foot, they added. 
 
 “Our image of Otto, as you know, was of someone just wonderful, beautiful inside and out. And to see how he came home was too much for us,” Cindy Warmbier said, her voice breaking. “I almost passed out, but I got it together, and I rode in the ambulance with him, because I did not want him to be alone anymore. 
 
 “He’d been alone for way too long. And we stayed with him and loved him as best as we could.” 
 
 In late 2015, Warmbier traveled with a tour group to North Korea on his way to a study-abroad program in Hong Kong but was not allowed to leave the country. After a sham trial in 2016, he was sentenced to 15 years of hard labor for what North Korea called “hostile acts against the state.” 
 
 Shortly after that, apparently, Warmbier was injured. He was denied consular visits, and his family had no word of him after March 2016, until they were told this June that he had been in a coma for more than a year. He was medically evacuated and arrived back in Cincinnati for treatment June 13. 
 
 Doctors said Warmbier had suffered extensive loss of brain tissue, consistent with cardiopulmonary arrest, and was in a state of unresponsive wakefulness. They were unsure what had caused the brain damage: He did not show any obvious indications of trauma, nor evidence of either acute or healing fractures. However, they also were not aware of anything from his previous medical history, before his time in North Korea, that might have caused cardiopulmonary arrest. 
 
 Warmbier died less than a week later, on June 19. 
 
 [What happened to Otto Warmbier? When the unthinkable is unknowable.] 
 
 “We weren’t prepared for what we had, and then when we saw Otto the way he was, we loved him, we’re proud of him — but no mother, no parent should ever have gone through what we went through,” Cindy Warmbier said Tuesday on Fox News. “And the fact that Otto was alone, all that time, with no one to comfort him, is inexcusable. Whatever happened — I mean, why would you do this?” 
 
 She added that she felt he had only been sent home because he was about to die. 
 
 Fred Warmbier reiterated that North Korea should be listed as a state sponsor of terrorism. 
 
 “It was astounding to Cindy and I to discover that North Korea is not listed,” he said. “ … We owe it to the world to list North Korea as a state sponsor of terror.” 
 
 The State Department “strongly warns” U.S. citizens not to travel to North Korea, “due to the serious and mounting risk of arrest and long-term detention of U.S. citizens.” 
 
 A State Department official told The Washington Post the department holds North Korea accountable for Otto Warmbier’s “unjust imprisonment” and extended condolences to his family. 
 
 The review of intelligence from North Korea was an “ongoing process,” said the official, who spoke on the condition of anonymity under State Department rules for briefing reporters. 
 
 “As a matter of law, in order for any country to be designated as a state sponsor of terrorism, the Secretary of State must determine that the government of that country has repeatedly provided support for acts of international terrorism. These designations are made after careful review of all available evidence to determine if a country meets the statutory criteria for designation,” the official said. “The Department of State will take immediate action if credible evidence supports North Korea’s designation as a state sponsor of terrorism under the statutory criteria.” 
 
 North Korea used to be on the department’s list of state sponsors of terrorism, placed there in 1988 for selling weapons to terrorist groups and its involvement in the 1987 bombing of a Korean Air flight over the Andaman Sea. But North Korea’s designation was removed in 2008 by President George W. Bush for meeting all the requirements for nuclear inspections. There have since been growing calls for the Trump administration to re-list it. 
 
 Shortly after the “Fox & Friends” interview aired, President Trump made it clear he had been watching by tweeting his approval of the segment. 
 
 Great interview on @foxandfriends with the parents of Otto Warmbier: 1994 - 2017. Otto was tortured beyond belief by North Korea. — Donald J. Trump (@realDonaldTrump) September 26, 2017 
 
 Carol Morello contributed to this report. 
 
 Read more: 
 
 North Korea calls Otto Warmbier’s death a ‘mystery,’ casts itself as ‘biggest victim’ 
 
 ‘Let’s bring it in’: Otto Warmbier’s family and friends celebrate his life at memorial 
 
 Otto Warmbier’s North Korea roommate speaks out 
 
 Fred Hiatt: Why I can’t stop thinking about Otto Warmbier ||||| WYOMING, Ohio (Reuters) - An American university student who was returned to the United States this week after being held in North Korea for 17 months has a severe brain injury and is in a state of “unresponsive wakefulness,” doctors said on Thursday. 
 
 Otto Warmbier, 22, who arrived in the United States on Tuesday, is stable but “shows no sign of understanding language, responding to verbal commands or awareness of his surrounding,” said Dr. Daniel Kanter, medical director of the neuroscience intensive care unit at the University of Cincinnati Medical Center. 
 
 “He has not spoken,” Kanter said at a news conference. “He has not engaged in any purposeful movements or behaviors.” He said Warmbier was breathing on his own. 
 
 Read the Reuters backstory 
 
 Warmbier, from Wyoming, Ohio, has been in a coma since March 2016, shortly after he was sentenced to 15 years of hard labor in North Korea, his family said on Tuesday. 
 
 He was arrested for trying to steal an item bearing a propaganda slogan, North Korean media reported. He was visiting North Korea with a tour group. 
 
 On Thursday, North Korea said that it had released Warmbier “on humanitarian grounds.” 
 
 The University of Virginia student’s father, Fred Warmbier, said at an earlier news conference that his son had been “brutalized and terrorized” by the North Korean government. 
 
 Fred Warmbier said the family did not believe North Korea’s story that his son had fallen into a coma after contracting botulism and being given a sleeping pill. 
 
 Doctors said on Thursday that there was no sign of botulism in Otto Warmbier’s system. 
 
 Kanter said that Warmbier had suffered “extensive loss of brain tissue in all regions of the brain,” but he declined to discuss Warmbier’s prognosis at the request of his family. 
 
 FILE PHOTO - Otto Frederick Warmbier, a University of Virginia student who has been detained in North Korea since early January, attends a news conference in Pyongyang, North Korea, in this photo released by Kyodo February 29, 2016. Mandatory credit REUTERS/Kyodo 
 
 While doctors are uncertain as to what exactly caused the condition, cardiac arrest that stops the flow of blood to the brain is generally seen as resulting in the death of brain tissue. 
 
 Cardiac arrest in young, healthy people is rare and generally caused by either intoxication or traumatic injury, Dr. Jordan Bonomo, a specialist in neurosurgery and neurocritical care at the University of Cincinnati Medical Center, said at the news conference. 
 
 Although doctors had no information about the type of medical treatment Warmbier received while in North Korea, they did receive MRI images from North Korea dated April 2016, Kanter said. Based on those images, doctors estimate the brain injury likely occurred in the preceding weeks, he said. 
 
 Doctors said there was no evidence that Warmbier suffered any broken bones. 
 
 On Thursday, the State Department said that its special envoy on North Korea, Joseph Yun, who negotiated Warmbier’s release during a visit to the country this week, had also met with three other U.S. citizens being held in North Korea. 
 
 Tensions between the United States and North Korea have been heightened by North Korean missile launches and two nuclear bomb tests. Pyongyang has vowed to develop a nuclear-tipped intercontinental ballistic missile capable of hitting the U.S. mainland. 
 
 Fred Warmbier said he was stunned when told of his son’s condition one week ago. 
 
 “I don’t know what being in shock is, but I’m pretty sure I was,” he said. 
 
 “There is no excuse for any civilized nation to have kept his condition secret and denied him top-notch medical care for so long.” 
 
 He said his wife, Cindy, had not left their son’s side since his return to the United States and that he had spoken with U.S. President Donald Trump on Wednesday night. 
 
 U.S. Secretary of State Rex Tillerson told reporters on Thursday, “We’re glad he’s home.” He said officials would not comment on Warmbier’s health or how he came to be in his current condition. 
 
 Slideshow (5 Images) 
 
 Tillerson said on Wednesday that U.S. officials were considering some type of travel visa restriction to North Korea. 
 
 U.S. lawmakers introduced a bill last month that would ban U.S. citizens from traveling to North Korea as tourists and require them to obtain special permission for other types of visits, following the detention of at least 17 Americans there in the past decade. 
 
 In Wyoming, a northern Cincinnati suburb of about 8,000 people, Warmbier’s return to the United States was marked by blue and white ribbons, representing the colors of the local high school, tied around trees and telephone polls. ||||| CLOSE The Hamilton County coroner said Wednesday she found no signs of broken bones on Otto Warmbier’s body, nor did she find that his teeth had been disfigured while he was imprisoned in North Korea as his parents claimed this week. 
 
 Buy Photo Signs are placed in a yard in Wyoming as the community prepared for the funeral of Otto Warmer, 22, at Wyoming High School. (Photo: The Enquirer/ Liz Dufour)Buy Photo 
 
 The Hamilton County coroner said Wednesday she found no signs of broken bones on Otto Warmbier’s body, nor did she find that his teeth had been disfigured while he was imprisoned in North Korea as his parents claimed this week. 
 
 “We don’t have enough information about what happened to Otto at that initial insult to draw any concrete conclusions” about how Warmbier died, Dr. Lakshmi Sammarco told a news conference at her Corryville office. 
 
 The coroner convened the session with reporters after Fred and Cindy Warmbier of Wyoming appeared on national television Tuesday to say their 22-year-old son had been tortured and “destroyed” in more than a year in North Korean custody. 
 
 Sammarco acknowledged the parents’ bereavement, which was why, she said, that she did not announce completion this month of a final report in Warmbier’s death, which The Enquirer obtained Tuesday. 
 
 But she said she felt the need to speak publicly when the Warmbiers claimed in their TV appearances on Fox News that Otto’s teeth looked like they had been “rearranged” with a pair of pliers. 
 
 More: What killed Otto Warmbier? Coroner's report only deepens mystery 
 
 Fred Warmbier, reached by The Enquirer after Sammarco’s news conference Wednesday, said, “We have no comment.” 
 
 CLOSE Hundreds paid tribute to Otto Warmbier, who died Monday afternoon, at Wyoming High School in Wyoming, Ohio. Warmbier had been imprisoned in North Korea since Jan. 2016, when he was 22. He returned last week to his family in a coma. Carrie Cochran 
 
 Warmbier died June 19, six days after North Korea released him. Once the severity of his brain injury was measured, Sammarco said, his parents directed physicians at UC Medical Center to keep him comfortable with sedation and to remove feeding tubes. 
 
 His parents refused an autopsy, so Sammarco’s office conducted a physical examination of his body and performed a CT scan, “which we call a virtual autopsy,” she said. She said she was surprised by the Warmbiers’ statements on TV, so on Tuesday, she asked Cincinnati forensic dentist Dr. Frank Wright to review the pathology reports. Wright reported that he found no damage to Otto Warmbier’s teeth. 
 
 “They’re grieving parents. I can’t really make comments on their perceptions,” Sammarco said. “But we here in his office, we depend on science for our conclusions. If we don’t have the science, we don’t conjecture.” 
 
 Sammarco, a neuroradiologist, was elected coroner as a Democrat in 2012 and re-elected last year. . 
 
 The final coroner's report said Warmbier had no broken bones or missing digits. The body did have about 10 scars of varying ages, with the newer ones consistent with medical care. 
 
 The parents’ statements occurred as U.S.-North Korea relations have hit a 50-year low. The Asian nation has been testing missiles capable of carrying nuclear warheads, and President Trump has threatened to destroy North Korea if it endangers the United States or its allies. 
 
 At her news conference, Sammarco said it was impossible to determine what injured Warmbier’s brain. Either blood flow was cut, or his heart stopped long enough to damage his brain, and, “We don’t know the root cause of that,” she said. 
 
 “The family is looking for answers that at this point, we’re never going to know,” Sammarco said, “unless the people who were there at the time would say, this is what happened.” 
 
 The official North Korean statement when Warmbier returned to Cincinnati in June was that while a prisoner, he had come down with botulism poisoning, which can occur from eating spoiled food, and then had taken a sleeping pill. 
 
 The proper treatment for botulism is an antitoxin, not a sleeping pill. Sammarco said she could not say whether Warmbier had indeed experienced botulism because any trace would have left his body long ago. 
 
 She did say that for being bedridden for more than a year, “His body was in excellent condition. His skin was in excellent condition. There was no evidence of bedsores. … I’m sure he had to have round-the-clock care to be able to maintain the skin in the condition it was in.” 
 
 Warmbier, a student at the University of Virginia and an experienced traveler, went to North Korea in December 2015 on a tour. On Jan. 2, 2016, as he was in line to board a plane to leave the county, he was arrested and charged with stealing a poster from a hotel. 
 
 The government tried and convicted him and in March 2016 sentenced him to 15 years at hard labor. He also was forced to read a propaganda statement that his trial had been “fair and square.” The brain injury occurred a short time later: North Korean medical records that traveled with Warmbier back to Cincinnati revealed the brain damage by April 2016. 
 
 After Warmbier’s funeral, North Korea denied torturing him. "Although we had no reason at all to show mercy to such a criminal of the enemy state, we provided him with medical treatments and care with all sincerity on a humanitarian basis until his return to the U.S." 
 
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– When Otto Warmbier was returned from North Korea last week after being held for more than a year, he was in a state of "unresponsive wakefulness" but otherwise stable—until he died suddenly Monday. Now NBC News reports doctors are trying to figure out what happened. One expert says Warmbier's family may have decided not to treat a medical issue—such as pneumonia, or sepsis, or a urinary tract infection—given that Warmbier was unlikely ever to recover from his vegetative state. Another says Warmbier may have suffered a pulmonary embolism, with his long flight from North Korea making a blood clot more likely. Here's what else you need to know about Warmbier and North Korea following the 22-year-old's death: We should have more details on Warmbier's death late Tuesday or Wednesday when the coroner releases initial autopsy findings, Reuters reports. The Cavalier Daily reports the University of Virginia Student Council will hold a vigil for Warmbier at 9pm Tuesday on campus. "The thoughts and prayers of the University of Virginia Student Body are with the Warmbier family and all those who loved Otto," the council said in a statement. Warmbier's funeral will be held Thursday morning at Wyoming High School in Ohio, ABC News tweets. Despite Trump's apparent willingness to sit down with Kim Jong Un, experts say Warmbier's death dramatically reduces—if not outright kills—chances for an improved relationship between the US and North Korea. "There is going to be a lot of anger," the director of the US-Korea Institute at Johns Hopkins School of Advanced International Studies tells the New York Times. Time reports South Korean President Moon Jae-in condemned North Korea's "unjust and cruel treatment" of Warmbier without outright accusing its government of murder. "We cannot know for sure that North Korea killed Mr. Warmbier," Moon said. "But I believe it is quite clear that they have a heavy responsibility in the process that led to Mr. Warmbier's death."