Sudden, unexpected death may, on rare occasion, be due to an undiagnosed primary brain tumor. In a study of l0,995 consecutive medicolegal autopsies in Dallas, Texas, DiMaio et al. found 19 sudden, unexpected deaths due to primary intracranial neoplasms, an incidence of 0.17%.51 In another study of 17,404 autopsies performed at the Brooklyn Office of the Medical Examiner, DiMaio and DiMaio found an incidence of 0.16% of sudden, unexpected deaths due to primary intracranial neo-plasm.53
In the 19 deaths due to primary intracranial neoplasm reported by DiMaio et al., nine (47.4%) were in the astrocytoma-glioblastoma category.52 The remainder included four cases of oligodendroglioma and one case each of medulloblastoma, microglioma, meningioma, teratoma, colloid cyst, and pituitary chromophobadenoma (Figure 3.11). Six deaths occurred following abrupt loss of consciousness or the individuals were found dead. Five of these had no known preceding symptoms. Thirteen individuals had symptoms of increased intracranial pressure, epilepsy, and psychiatric manifestations. Comparison of
the duration and the type of symptoms exhibited by these patients and those of a hospital patient population in which death was caused by a previously diagnosed primary intracranial neoplasm revealed that there was a shorter duration of acute symptomatology in the sudden, unexpected death cases seen by the medical examiner. The symptoms also tended to be nonlocalizing and there was a lack of progression or change of symptoms in those patients in whom epilepsy was a primary manifestation of their underlying disease. There was also a lower incidence of focal neurological deficits as presenting symptoms.
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