Unusual Case Of Sudden Death Research Articles

Sudden death in a case of recurrent Takotsubo syndrome.

Herein we report an unusual case of sudden death occurring in a 65 year old woman during a minor oral surgery. The subject, who had a medically treated anxiety, had a history of two reversible left ventricle dysfunction episodes consistent with recurrent Takotsubo Syndrome that had occurred seven and six years before, respectively. She also suffered from moderate, well treated post-menopausal systemic hypertension. Post-mortem examination showed apical biventricular ballooning of the heart with no cardiac rupture, coronary artery lesion or other cardiac/extra-cardiac disease. Toxicological tests and forensic investigations excluded unnatural causes of death, including pharmacological or iatrogenic causes related to medical malpractice. Only non-specific contraction bands and mild hypertrophy were observed by histology in the left ventricle myocytes. Takotsubo syndrome is usually an acute and reversible heart failure syndrome with acute left ventricle apex ballooning, no coronary artery disease or other macroscopic or microscopic cardiac changes; physical or emotional stress are well known triggering factors. Nevertheless, recurrent forms, major cardiac adverse events and even sudden death may occur in a minority of cases, meaning that a diagnosis of Takotsubo syndrome must be considered in cases of sudden death and in forensic investigations.

Two Unusual Cases of Sudden Death in Children

We report two unusual cases of sudden unexpected death in children. Histopathologic examination showed intimal fibroplasias, a variant of fibromuscular dysplasia of the right coronary artery associated in both cases with fatty infiltration of the right ventricular myocardium. The significance of this particular combination of two lesions known to induce a sudden death in young people is discussed.

Sudden death of an infant with coronary involvement due to Takayasu arteritis

We present an unusual case of sudden death of an 8-month-old female infant with coronary involvement due to Takayasu arteritis. She had been thought to be healthy, but died after presenting to a hospital with complains of vomiting. At autopsy, the aorta and its main branches were thickened and stenotic, with the abdominal aorta below the level of the orifice of renal arteries most severely affected. The ascending aorta was thickened and showed ostial stenosis in the coronary arteries bilaterally. The proximal segment of the left and right coronary arteries showed approximately 60% and over 90% occlusion, respectively. Microscopically, the intima was thickened due to an increase of intimal cells and fibers, and the adventitia showed thickening with fibrosis. In addition, remarkable infiltration of inflammatory cells, including multinuclear giant cells phagocytosing fragmented elastic fibers, and destruction of elastic fibers were observed in the media. We diagnosed the cause of death as coronary insufficiency induced by coronary involvement due to Takayasu arteritis. Takayasu arteritis was not considered as a cause of sudden infant death, although this disease can affect the coronary artery. This report suggests that Takayasu arteritis can be a life-threatening condition even in infants.

Macrophage activation syndrome: An autopsy case of sudden death

In a context of viral gastroenteritis, we report an unusual case of sudden death in an 8-year-old child. The only macroscopic abnormality observed in the autopsy was a diffuse mesenteric adenitis. Organ samples were taken for histopathological examination and a diffuse lymphocytic infiltration was observed. A sinusoidal histiocytic hyperplasia was found in the lymph nodes. Microscopic examination of the lungs and the lymph nodes revealed haemophagocytic lesions (lymphocytes within the cytoplasm of histiocytic macrophages). Immunohistochemical studies demonstrated that the histiocytes were CD68+ PS100− CD1A−. Following this microscopic examination macrophage activation or haemophagocytic syndrome was diagnosed. The syndrome is a distinct clinical entity characterised by fever, pancytopaenia, splenomegaly, and haemophagocytosis in the bone marrow, liver and lymph nodes. It is a clinical entity that is very difficult to diagnose due to the lack of specific clinical signs. It is generally a complication of an infectious process, an aggravation of an auto-immune disease or a complication of a neoplastic process. The physiopathology involves a disregulation of T lymphocytes and particularly T helper lymphocytes. To make this diagnosis the anatomopathological examination must be performed by an experienced practitioner. The presence of a lymphocyte infiltrate of macrophagic histiocytes in myeloid organs and especially positive CD68+ immune markers are the anatomopathological proofs of diagnosis. The autopsy examination must be carefully performed and include systematic sample harvesting for anatomopathological examination. The results of all these examinations taken together allow the diagnosis of haemophagocytic syndrome to be finally made.

Sudden natural death in a suicide attempt.

In this article, we report an unusual case of sudden death arising from a ruptured basilar artery aneurysm during a suicide attempt. A 72-year-old male was found dead in his home after sustaining superficial flesh gunshot wounds (entrace and exit) involving the forehead. The victim had been depressed for several months and had frank suicide intention. The pertinent autopsy findings revealed a superficial nonpenetrating bullet path of the scalp with no skull fractures or brain injuries. However, brain examination identified subrachnoid hemorrhage and subdural clot about the brainstem and within the posterior fossa, linked to a basilar artery aneourysm rupture. The cause and manner of death and contributing factors of the "non-lethal" gunshot wounds are discussed.

Cerebrovascular Malformation Causing Sudden Death

Three unusual cases of sudden death resulting from cerebrovascular malformation (CVM) are presented. CVMs are highly variable in location and morphology, and may be difficult to detect. Two of the patients discussed here had CVMs that involved the circle of Willis directly, and produced rapidly fatal subarachnoid hemorrhage at the base of the brain; both of these subjects were in their late 30s. One had a history of epilepsy; the other had been completely asymptomatic prior to the catastrophic event. The third was an asymptomatic 6 year old with a cerebellar CVM, who survived long enough for inconclusive neurosurgical intervention. In all three cases, the diagnosis was not made prior to autopsy; in one case, the circumstances of death were initially misleading. The relevant literature is reviewed and discussed, with emphasis on differential diagnosis, anatomic examination, and background investigation.

Pulmonary arterial dissections and ruptures: To be considered in patients with pulmonary arterial hypertension presenting with cardiogenic shock or sudden death

Four unusual cases of sudden death due to pulmonary arterial hypertension complicated by dissection and/or rupture of the main pulmonary artery are reported. The patients, 3 males and 1 female, ranged from 17 to 77 years old. Each had chronic pulmonary arterial hypertension, marked pulmonary arterial dilation and degenerative medial changes of the large elastic pulmonary arteries. The first patient had a partial thickness tear of the main pulmonary artery with local dissection without external rupture and died of shock. The other three patients died after external rupture of the main pulmonary artery, based on a full thickness tear in one case, a small dissection in another and extensive dissection in the third. In the setting of pulmonary arterial hypertension, dissection, rupture, or dissection and rupture of the pulmonary artery should be considered in the differential diagnosis when patients present in cardiogenic shock or with sudden death.

Lethal inflammatory pseudotumor masquerading as “Laryngitis”

An unusual case of sudden death in a healthy young man due to an inflammatory pseudotumor (polyp) of the larynx is presented. An indirect laryngoscopy performed in the emergency department or accomplishment of a thorough follow-up ear, nose, and throat examination may have been lifesaving in this patient.

Embryonal carcinoma. An unexpected cause of sudden death in a young adult.

SUDDEN death occurring in young adults is rare. Luke and Helpern 1 reviewed 275 consecutive cases of sudden death in patients between the ages of 28 and 44 years and found that of these deaths, 38% were caused by coronary arterial atherosclerosis, 26% by fulminant untreated infectious diseases, and 4% by pulmonary arterial emboli. Seven of the 11 patients who died of pulmonary arterial emboli were women. Pelvic veins contained thrombi in two of 11 patients, and thrombi were found in the veins of the lower extremities in the remaining nine. This communication reports an unusual case of sudden death caused by pulmonary arterial emboli in a young man. Report of a Case A 21-year-old white man was perfectly well until, while at work and having had just returned from a coffee break, he fell to the floor. He was found without a palpable pulse or detectable respiratory movement. Resuscitation

Embryonal Carcinoma

SUDDEN death occurring in young adults is rare. Luke and Helpern¹reviewed 275 consecutive cases of sudden death in patients between the ages of 28 and 44 years and found that of these deaths, 38% were caused by coronary arterial atherosclerosis, 26% by fulminant untreated infectious diseases, and 4% by pulmonary arterial emboli. Seven of the 11 patients who died of pulmonary arterial emboli were women. Pelvic veins contained thrombi in two of 11 patients, and thrombi were found in the veins of the lower extremities in the remaining nine. This communication reports an unusual case of sudden death caused by pulmonary arterial emboli in a young man. <h3>Report of a Case</h3> A 21-year-old white man was perfectly well until, while at work and having had just returned from a coffee break, he fell to the floor. He was found without a palpable pulse or detectable respiratory movement. Resuscitation