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ISSN: 2165-7920

Journal of Clinical Case Reports
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Case Report

Acting Out of the Ordinary: A Case of Sudden Death after Abnormal Behavior Due to a Craniopharyngioma

Amal Nishantha Vadysinghe1, Paneetha Senavirathna2, Achini Samaranayake1 and Medhani Hasanthika Priyadarshi Wickramasinghe1*

1Department of Forensic Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka

2District General Hospital, Polonnaruwa, Sri Lanka

*Corresponding Author:
Hasanthika Priyadarshi Wickramasinghe
Department of Forensic Medicine, Faculty of Medicine
University of Peradeniya, Peradeniya, Sri Lanka
Tel: +94767424567
E-mail: [email protected]

Received date: July 23, 2016; Accepted date: November 24, 2016; Published date: November 30, 2016

Citation: Vadysinghe AN, Senavirathna P, Samaranayake A, Wickramasinghe MHP (2016) Acting Out of the Ordinary: A Case of Sudden Death after Abnormal Behavior Due to a Craniopharyngioma. J Clin Case Rep 6: 891. doi: 10.4172/2165- 7920.1000891

Copyright: © 2016 Vadysinghe AN, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

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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