Amal Nishantha Vadysinghe, Paneetha Senavirathna, Achini Samaranayake and Medhani Hasanthika Priyadarshi Wickramasinghe
Introduction: We report a patient who initially presented with behavioral changes for a short period and then succumbed to unexpected death while on psychiatric treatment. The cause of death was found to be a craniopharyngioma at medico-legal autopsy.
Case report: A previously apparently healthy, 52-year old female, started showing disinhibited behavior such as removing clothes in public and was consequently treated with antipsychotics for two weeks. Behavioral symptoms improved gradually but she complained of intermittent difficulty in maintaining balance. A week later she was found dead at home in her bed. Medico-legal autopsy and subsequent investigations revealed severe cerebral edema resulting from a well formed craniopharyngioma with surrounding cystic degeneration at pituitary gland. The optic chiasma was partially displaced by the tumor. Moderate pulmonary edema was seen. Examination of other systems, toxicology and microbiological investigations were unremarkable. The cause of death was given as cerebral edema due to craniopharyngioma.
Discussion: The patient was initially treated as having a mental illness. This reflects the importance of excluding organic causes early and considering neurological assessment in previously well patients who suddenly presented with psychiatric symptoms. Autopsy findings are consistent with acute hydrocephalus due to growing brain tumor. The enlarged gland had encroached on the basal cisterna, obstructing the cerebral spinal fluid pathway, and causing acute hydrocephalus. This was speculated to have resulted in sudden death.
Conclusion: This case exemplifies the medico-legal autopsy role in determining causes of death.
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