1/13. Sudden death in an infant caused by rupture of a basilar artery aneurysm.Ruptured aneurysms of the cerebrovasculature in infancy and early childhood, except for "giant" aneurysms and arteriovenous malformations, are rare. seizures, loss of consciousness, and apnea are the usual presenting signs in infancy; symptoms such as headache or visual disturbances and signs such as cranial nerve compression or meningeal irritation commonly found in older children or adults are absent in infants. However, the morphologic findings (i.e., subarachnoid and retinal hemorrhage, and occasionally subdural hemorrhage) may be mistaken for inflicted trauma, especially if the aneurysm is not identified. Sudden death caused by rupture of a cerebral aneurysm has not been previously described in an infant. This report outlines the investigation and autopsy findings in a 7-month-old infant who died unexpectedly as a result of rupture of a complex basilar artery aneurysm.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
2/13. Sudden unexpected death associated with HHV-6 in an adolescent with tuberous sclerosis.A 14-year-old female with tuberous sclerosis and history of seizures was found dead in bed at home 3 days after she had been assessed as doing well at a routine neurology clinic appointment. She had been treated with an antiepileptic drug, felbamate, for 36 months and had been seizure-free except for one seizure episode 5 months before death. Postmortem examination revealed cerebral edema, with uncal and tonsillar herniation, and pulmonary edema, consistent with seizure-induced apnea. Multiple microglial nodules with mature perivascular lymphocytic cuffing and diffuse infiltrates were identified around subependymal tuberous sclerosis giant cell nodules. Immunostaining and electron microscopy revealed human herpesvirus-6-infected macrophages, astrocytes, lymphocytes, and endothelial cells in the subependymal tuberous sclerosis lesions and choroid plexus. Subacute human herpesvirus-6 encephalitis is postulated to have precipitated a seizure and thus sudden unexpected death in epilepsy in this otherwise stable adolescent patient.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
3/13. A survivor of near sudden death caused by giant left atrial myxoma.Sudden hemodynamic collapse occurred in a 20-year-old man after an Emergency Department visit with a complaint of dizziness and chest discomfort. A left atrial myxoma was demonstrated by echocardiography. resuscitation procedures followed by surgical repair resulted in an excellent outcome. Although sudden death is a serious manifestation of cardiac myxoma, reports of survivors of near sudden death caused by this tumor have been rare.- - - - - - - - - - ranking = 4keywords = giant (Clic here for more details about this article) |
4/13. Sudden death caused by myocardial tuberculosis: case report and review of the literature.A 25-year-old fit man died suddenly while playing social soccer. autopsy revealed an infiltrative lesion involving the left ventricle with overlying pericarditis. No other significant pathologic changes were observed. Histologic examination showed necrotizing granulomatous inflammation. No acid-fast bacilli were demonstrated in the pericardial fluid or on histologic examination. The presence of mycobacterium tuberculosis dna complex was confirmed by use of the ligase chain reaction technique. The differential diagnosis of myocardial tuberculosis includes sarcoidosis, rheumatic fever, rheumatoid arthritis, giant-cell-containing tumors, idiopathic (giant-cell) myocarditis, and bacterial infections such as tularemia and brucellosis. This case illustrates the protean manifestations of tuberculosis and highlights the use of molecular biologic techniques in arriving at a definitive diagnosis in cases of suspected tuberculosis.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
5/13. An autopsy case of sudden death in a patient with giant cell myocarditis.We present a case of a 28-year-old male weight lifter who died suddenly while driving a bicycle. Forensic autopsy and histopathological examinations revealed granulomatous lesions in the myocardium and hilar lymph nodes. The latter had massive caseation necrosis, epithelioid granulomas and Langhans' giant cells suggestive of tuberculosis. However, the myocardium showed predominantly multinucleated foreign body and myogenic giant cells, lymphocytes, plasma cells, macrophages, eosinophils. Staining for acid-fast bacilli was negative. The present case highlights the difficulty in establishing whether the granulomatous lesions in the hilar lymph nodes and the myocardium are incidental findings or whether they are related by the same pathogenetic mechanisms.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
6/13. Severe granulomatous giant cell myocarditis in Wegener's granulomatosis.A 28-year-old male patient suffering from Wegener's granulomatosis died suddenly with signs of cardiac failure after clinical symptoms had basically subsided under chemotherapy. autopsy revealed pulmonary granulomata, necrotizing vasculitis of the lungs and kidneys, focal and segmental necrotizing glomerulonephritis, and diffuse granulomatous and necrotizing giant cell myocarditis. Histological confirmation of inflammation of the heart in Wegener's disease has rarely been reported. Although cardiac involvement in Wegener's granulomatosis sometimes is suspected, it is usually thought to have no major impact on the course of the disease. By its dramatic clinical and morphologic presentation this case illustrates that the heart, in addition to the lungs and kidneys, may determine the outcome of the idiopathic granulomatous vasculitis of Wegener.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
7/13. Sudden death in idiopathic giant cell myocarditis.A rare case of idiopathic giant-cell myocarditis fatally affecting a middle-aged woman is presented. The circumstances of the fulminant and unexpected death were witnessed and reported by a relative. The confusing aspects of the 'Fiedler's myocarditis', the relation with more common forms of viral myocarditis and finally the medico-legal importance in the context of the sudden and natural death are mentioned.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
8/13. Subependymoma and unexpected death.A previously healthy 53-year-old man died suddenly and unexpected. The main finding at the post mortem examination was a large 4th ventricle subependymoma, a rare brain tumour related to the ventricles of the brain. The salient features of subependymoma are described with emphasis on the microscopic picture and distinction from subependymal giant cell astrocytoma, as the tumour harboured large, bizarre astrocytes. Coronary atherosclerosis and mild cardiac hypertrophy were present as the only pathologic changes outside the central nervous system. The cause of death is discussed in light of earlier reports on brain tumours and sudden fatal incidents.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
9/13. Sudden unexpected death due to coronary giant cell arteritis.A previously healthy 19-year-old woman died two hours after the sudden onset of severe chest pain. The only gross abnormality seen at the time of autopsy was thrombosis of the left main coronary artery. Microscopic examination of the artery showed eccentric necrotizing arteritis with giant cells, associated with the thrombus. The aorta was infiltrated with lymphocytes, histiocytes, and an occasional giant cell. Sudden cardiac death as the initial manifestation of a giant cell arteritis that involves only the coronary artery and aorta is rare.- - - - - - - - - - ranking = 7keywords = giant (Clic here for more details about this article) |
10/13. Sudden death in epilepsy due to an isolated subependymal giant cell astrocytoma of the septum pellucidum.We report a case of sudden unexpected death in an individual with epilepsy. autopsy revealed a subependymal giant cell astrocytoma of the septum pellucidum, but there were no other lesions of tuberous sclerosis. We discuss sudden death in epilepsy, deaths related to primary brain tumors, the pathology of subependymal giant cell astrocytoma, and whether or not such a tumor can exist outside the setting of tuberous sclerosis. We also discuss the implications such findings may have on surviving family members, as well as the important role of the forensic pathologist in such cases.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
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