There are a few disorders of the central nervous system (CNS) that cause sudden and unexpected death. For example, brain tumors can cause sudden death, but people with tumors usually present to a physician with evidence of their disease prior to death. Occasionally, someone may die suddenly from an unsuspected and undiag-nosed rapidly growing tumor. Colloid cysts of the third ventricle may also cause a sudden unexpected death. Meningitis may present with nonspecific symptoms such as a headache and may not be diagnosed in an ER, but within hours the symptoms may progress rapidly and cause death before adequate medical attention is obtained.
The most common disorder of the CNS that causes a sudden death is a seizure. Seizures may be idiopathic (unknown cause) or acquired. If the decedent developed a seizure disorder as a result of blunt trauma to the head, death is not considered natural because the cause of death was the result of the trauma. Examples of acquired seizures from natural causes are accidents and tumors. It is important to recognize that the correct cause of death is the underlying disorder, not the seizure. Finally, there is a group of patients with seizures who have no underlying cause. In these deaths the cause of death may be ruled "idiopathic seizure disorder." The identification at autopsy of either a gross or microscopic abnormality in the brain that triggers the seizure is rarely found. Like cardiac arrhythmias, seizures are electrical activity which is not in itself detectable during the autopsy. Clearly, the decedent's history and the elimination of other causes of death are important when making the proper diagnosis.
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