1/18. Unexpected death in persons with symptomatic epilepsy due to glial brain tumors: a report of two cases and review of the literature.Two cases of unexpected death in persons with epileptic seizures due to a brain tumor are presented which encompassed an astrocytoma WHO grade II and an anaplastic astrocytoma WHO grade III. A 35-year-old man was found somnolent and disoriented at home. A computed tomography (CT) scan revealed a tumor of the right frontal lobe suggestive for an oligodendroglioma. During an angiographic examination the patient experienced an epileptic seizure. Some weeks later, the man was found dead in front of his house with a fresh bite mark of the tongue. Neuropathological examination revealed an astrocytoma WHO grade II of the right frontal lobe. A 47-year-old man plunged into a swimming-pool and was found submerged some minutes later. After resuscitation he survived comatose for 8 days but finally died due to severe hypoxic brain damage. He had been operated on a brain tumor of the temporal lobe 1 year before the accident. Neuropathological examination revealed residual tumor tissue at the operation site corresponding to an anaplastic astrocytoma WHO grade III. Although rare, death in persons with epileptic seizures due to brain tumors is an important mechanism of death encountered by the forensic pathologist.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/18. Sudden death due to rupture of an omental metastatic tumor arising from cardiac angiosarcoma. A case report.A 32-year-old man underwent surgical excision of a malignant hemangioendothelioma of the heart and received multidisciplinary treatment. Thirty-three months later, he underwent a second surgical treatment for a recurrent tumor of the posterior chest wall of the right thorax. Five months after this surgery (thirty-eight months after the initial surgery), a second recurrent tumor in the right thorax developed. Although radiotherapy and recombinant interleukin-2 were administered, anemia of unknown origin (hemoglobin 6.7 g/dl) developed. The patient died of sudden shock due to a rupture of an omental metastatic tumor. The patient survived for 41 months after the first surgical resection. We present this case because it is the first reported case of sudden death due to bleeding from an omental metastatic tumor, and because our patient was the second-longest survivor after surgical treatment for cardiac angiosarcoma.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
3/18. Granulocytic sarcoma (chloroma) in hiv patient: a report.Isolated chloromas (granulocytic sarcomas) are rare tumours. Chloromas are masses composed of immature granulocytic cells. Granulocytic sarcoma occurs primarily in patients with acute myelogenous leukaemia, but can also arise in patients with other myeloproliferative disorders. We present an adult case of chloroma in hiv patient, which occurred as sudden death. skin examination of right thigh showed dyschromia. Longitudinal incision of muscle revealed a "dark green" infiltration. pathology showed in muscle fragments a infiltrate of granulocytes. The histologic sections of the excised tumour confirmed the cytologic diagnosis of chloroma.- - - - - - - - - - ranking = 6keywords = coma (Clic here for more details about this article) |
4/18. Insomnia-coma and auto-electrocution complicating general anesthesia. Incidental factors which also cause cerebral, respiratory and cardiac arrest.Whatever induces general anesthesia, i.e. cerebral arrest, tends to cause respiratory and cardiac arrest also. However, general anesthesia does not necessarily exclude nor block all other mechanisms which can provoke one or more of these three phenomena. Amongst many such more or less equipotent factors are intracranial, intrapleural, intra-abdominal and intratracheal pressures. These mechanical factors occurring but unrecognized in surgical patients cause puzzling complications including, insomnia, coma and unexpected sudden death.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
5/18. Reye's syndrome. A diagnosis occasionally first made at medicolegal autopsy.Reye's syndrome, a condition characterized pathologically by cerebral edema and fatty change of the liver, has been described extensively in the medical literature as a disease manifested clinically by encephalopathy and coma. This is a report of five cases of Reye's syndrome occurring as sudden, unexpected deaths outside of the hospital. In each of these cases, there is a vague history of a previous viral illness. A history of aspirin intake is inconstant. Each child either had no significant past illnesses or there was a history of repeated upper respiratory infections. The classic progression of signs and symptoms usually described for Reye's syndrome, where vomiting usually precedes encephalopathy and coma, was not present in any of the cases. Results of autopsies showed the characteristic findings for Reye's syndrome, and additional tests showed no other explanation for the deaths. This manifestation of the disease is seldom described in medical literature, but it may be encountered occasionally by the medical examiner.- - - - - - - - - - ranking = 2keywords = coma (Clic here for more details about this article) |
6/18. Why do individuals with anorexia die? A case of sudden death.OBJECTIVE: The mechanism of death in anorexia nervosa (AN) is unclear. METHOD: We present a case of sudden death in AN with unexpected autopsy findings. A 36-year-old woman with long-standing AN presented to the eating disorders unit. She was severely underweight with a body mass index of 12.5. Ten days after admission, she went into coma with no obvious precipitant. RESULTS: Clinical examination and investigations failed to reveal its cause. Despite attempts at resuscitation, she died the following morning. A postmortem examination revealed multiple bilateral pulmonary thromboemboli and bilateral calf vein thrombosis. CONCLUSION: This case illustrates that in AN, pathology may not manifest with obvious clinical features. A high level of clinical vigilance is required. The cause of death in AN cannot reliably be established from antemortem clinical features. We recommend that any AN death be reported and that, where possible, an autopsy be performed. This may lead to advances in knowledge and treatment practices.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
7/18. pulmonary artery sarcoma: another cause of sudden death.A patient hospitalized for recurrent syncope and dyspnea died suddenly before a definite clinical diagnosis could be established. At autopsy a large sarcomatous mass (undifferentiated type) was found to arise and totally occlude the pulmonary trunk without evidence of distant metastasis.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
8/18. Hypoglycemic coma in anorexia nervosa. Case report and review of the literature.Clinically significant hypoglycemia is an unusual complication of anorexia nervosa. We describe a 44-year-old woman with a 5-year history of anorexia nervosa who presented with hypoglycemic coma and eventually experienced sudden death. Biochemical studies showed suppressed levels of insulin, C peptide, and proinsulin during hypoglycemia; appropriate elevations of growth hormone and cortisol levels were observed, suggesting that the hypoglycemia was related to severe malnutrition. Nine previously reported cases of severe hypoglycemia in anorexia nervosa are reviewed (six of the patients involved also died). The presence of severe hypoglycemia in anorexia nervosa implies a grave prognosis and mandates aggressive medical and nutritional therapy to improve the chance of survival.- - - - - - - - - - ranking = 5keywords = coma (Clic here for more details about this article) |
9/18. Sudden neurologic death after intrathecal methotrexate.methotrexate leukoencephalopathy is a chronic syndrome of ataxia and confusion which may progress to seizures, coma, and death. We report a fatal case of this syndrome in a patient who displayed no evidence of the typical prodrome of neurologic symptoms or signs. This patient suffered brain death after receiving 11 doses of intrathecal methotrexate for leukemic meningitis. Since leukoencephalopathy was not clinically suspected, this case underscores the need for a test that would reliably monitor central nervous system toxicity due to intrathecal therapy.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
10/18. Sudden and unexpected deaths after the acute onset of diabetes mellitus.Four cases of sudden and unexpected death caused by the acute onset of diabetes mellitus are reported. Three are examples of acute juvenile diabetes while the fourth demonstrated the aketotic form of diabetic coma. Such instances can present a diagnostic problem to the forensic pathologist. The usefulness of vitreous humor glucose analysis to diagnose such a condition is stressed.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
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