TRENTON — Kenwin Garcia was walking alongside Interstate 287 in Hanover Township.

Charles Arroyo was choking his mother on her bed in Egg Harbor City.

Mark Keseleski was standing near his burning car on the New Jersey Turnpike in Woodbridge.

Each wound up dead after a fight with police.

An NJ Advance Media analysis found they were among 10 people during the past decade in New Jersey who authorities said died after a case of excited delirium, a controversial medical syndrome, usually cited after struggles with police, that results in heart or respiratory failure.

Some police experts, physicians, researchers and medical examiners say the condition is real, and police officers are often wrongly accused of excessive force as a result of it. Critics say it’s poorly understood, vague and open to abuse by police or prosecutors.

“There is a very sharp split, even among forensic pathologists, who are the only ones to really use the diagnosis,” said Michael Baden, a former chief medical examiner for New York City and former director of the New York State Police Medicolegal Investigation Unit. Most recently, Baden conducted a private autopsy of Michael Brown, whose shooting by police in August in Ferguson, Mo., prompted widespread protests.

Limited research exists on excited delirium. Most journal articles and other published reports conclude it is real in some form, though they acknowledge the split in the medical community and the fact the exact cause and why it afflicts certain people is unknown.

It most often occurs when people become disoriented and delusional after taking drugs such as cocaine, and then become agitated and violent when approached by police, experts said. Proponents say it also occurs absent police, but those situations gain less attention and are poorly documented.

Delirium itself among drug users and the mentally ill has been recognized and accepted in scientific communities for years. But the more recent phenomenon of delirium leading to death after encounters with police has prompted confusion and heated debate.

‘Not oriented to reality’

Vincent Di Maio — who was the chief medical examiner in Bexar County, Texas, which includes San Antonio, for 25 years and who co-authored the leading book on excited delirium — said in most cases, police are called because someone is acting bizarrely, and officers intervene to restrain the person. The National Association of Medical Examiners and the American College of Emergency Physicians recognize the syndrome, and in April, the International Association of Chiefs of Police issued a white paper concluding, “despite what it is called or whether it has been formally recognized, it is a real clinical concern for both law enforcement and the medical communities.” But the American Medical Association and the American Psychological Association, among others, have taken no position.

“More research on the concept of ‘excited delirium’ needs to be undertaken,” said Kim Mills, spokeswoman for the psychological association.

The International Classification of Diseases, the gold standard for medical diagnoses, makes no mention of excited delirium, nor does its counterpart, the Diagnostic and Statistical Manual of Mental Disorders, though it does describe disorders similar to it.

Douglas Zipes, a internationally renowned cardiologist and distinguished

professor at Indiana University School of Medicine, said that while excited delirium may be real, particularly among drug users, it often does not adequately — and scientifically — explain someone's death.

“It’s a catch-all group of signs and symptoms of individuals and the only common denominator is agitated delirium,” said Zipes, an expert in heart rhythm and sudden death. “I find that very unacceptable.

“I am a clinician but also a scientist, and without having a scientific underpinning that would explain the mechanism as to how this happens, I find the diagnosis difficult to make and to accept.”

NJ Advance Media reporters S.P. Sullivan and Carla Astudillo contributed to this report.

Christopher Baxter may be reached at cbaxter@njadvancemedia.com. Follow him on Twitter @cbaxter1. Find NJ.com Politics on Facebook.