text: FILE – In this March 16, 2016, file photo, American student Otto Warmbier, center, is escorted at the Supreme Court in Pyongyang, North Korea. Fred and Cindy Warmbier, the parents of a young Ohioan who... (Associated Press) 
   
   CINCINNATI (AP) — A coroner said Wednesday her office could not determine what led to the fatal brain damage of a young Ohio man detained in North Korea for more than a year. 
   
   While the parents of 22-year-old Otto Warmbier and President Donald Trump have accused the North Korean government of torturing him, Dr. Lakshmi Sammarco said evidence has led to no "scientific facts" to solve Warmbier's mysterious death. 
   
   "We don't know what happened to him, and this is the bottom line," she said. The cause of the death may never be known, she added. 
   
   A coroner's report dated Sept. 11 shows the cause of death for the University of Virginia student as complications from brain-damaging oxygen deprivation through "an unknown insult more than a year prior to death." The medical term for his condition was called "chronic anoxic/ischemic encephalopathy." The manner of death was listed as "undetermined." 
   
   While Warmbier's family declined an autopsy, Sammarco said her office used extensive medical scanning and imaging for a "virtual autopsy" and that nothing more would have been gained by doing an autopsy so long after his brain damage occurred. 
   
   Warmbier's parents told a Fox News TV show Tuesday that North Korea tortured and "destroyed" him. Trump tweeted afterward: "Otto was tortured beyond belief by North Korea." Trump's tweet added to a series of recent accusations and heated exchanges between his administration and North Korean officials. 
   
   North Korea has denied mistreating Warmbier, sentenced to 15 years of hard labor in March 2016 for allegedly stealing a propaganda poster two months earlier. North Korea has claimed Warmbier fell into a coma that resulted from botulism and a sleeping pill. 
   
   Sammarco agreed with University of Cincinnati Health system doctors who treated Warmbier and said they found no evidence of botulism or evidence of fractures or healing fractures that might point to beatings. She said a forensic dentist agreed with her conclusion there was "no evidence of trauma" to Warmbier's teeth. 
   
   Fred Warmbier said on TV that his son's mouth "looked like someone had taken a pair of pliers and rearranged his bottom teeth." 
   
   Sammarco said Warmbier's body, including his skin, was in surprisingly good condition for someone who had reportedly been bedridden for more than a year, indicating he received regular care. Her office's report said his body appeared "well-nourished." There were multiple scars and bruises, some apparently stemming from medical procedures. 
   
   He died in Cincinnati in June 2017, less than a week after his return to the U.S. Sammarco said Warmbier was put on "comfort care" measures, such as removing a feeding tube. 
   
   The parents on Tuesday, for the first time, described the condition his family found him in when they went aboard an air ambulance that arrived June 13 in Cincinnati. His father said he was making an "involuntary, inhuman sound," "'staring blankly into space jerking violently," and was blind and deaf with his head shaved. 
   
   UC Health doctors said in June that Warmbier was in a state of "unresponsive wakefulness" and had suffered a "severe neurological injury" of uncertain cause. 
   
   His father didn't respond immediately Wednesday to requests for comment. 
   
   ___ 
   
   AP Medical Writer Lauran Neergaard in Washington contributed to this report. Follow Dan Sewell at http://twitter.com/dansewell ||||| (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. ||||| 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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target: – The death of Otto Warmbier is a mystery and it will probably stay that way unless somebody from North Korea comes forward with information, Hamilton County Coroner Lakshmi Sammarco says. At a press conference in Cincinnati Wednesday, the coroner said the American student's death was caused by complications from brain-damaging oxygen deprivation around six months into his imprisonment in North Korea, but the cause of the initial "insult" could not be determined, reports Reuters. "We don't know what happened to him, and that's the bottom line," she said. Warmbier's family declined an autopsy, but Sammarco said a CT scan served as a "virtual autopsy." Sammarco, whose report stated there were no signs of torture on Warmbier's body, said he had apparently been well cared for during the year or more he was bedridden, the AP reports. Sammarco said she decided to speak to the press after Warmbier's parents told national media he had been tortured and "destroyed," the Cincinnati Enquirer reports. She said a forensic dentist found no damage to the 22-year-old's teeth, which father Fred Warmbier said looked like they had been rearranged with pliers. "They're grieving parents. I can't really make comments on their perceptions," she 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."