Sudden natural death due to takayasu’s arteritis.

A young male aged 23 yrs with alleged history of chest pain was brought to the emergency medicine department of St John’s Medical college hospital. On arrival was declared brought dead. There was no previous significant medical history. A Medico-legal autopsy was done which revealed left anterior descending coronary artery lumen to be occluded by grey white material. On Histo-pathological examination of the heart, it was diagnosed as Takayasu’s arteritis. Takayasu arteritis, also known as Pulseless disease, occlusive thromboaortopathy, and Martorella syndrome, It is a Granulomatous inflammation of unknown aetiology affecting medium and large arteries leading to vessel wall thickening and occlusion . Females are more likely to be affected than males. Patients often notice the disease symptoms between 15- 30 years of age. Symptoms range from malaise, fever, night sweats, weight loss, arthalagia, fatigue and can present with absent pulses, limb claudication, blood pressure, discrepancies, Hypertension, retinopathy Ischemia, postural dizziness, seizures, hemi paresis and many more. Sudden death due to Takayasu’s arteritis affecting coronary artery is rarely reported during medico-legal autopsy, hence this case is reported.

Adult choroid plexus papilloma: cause of sudden death.

Choroid plexus papilloma (CPP) is a rare, benign neoplasm, relatively more common in childhood. It is associated with signs and symptoms of increased intracranial pressure, frequently in association with obstructive hydrocephalus. CT and MRI are the investigations of choice and are diagnostic. Sudden deaths have been reported, but are very unusual. A 41 year old male was brought for medico-legal autopsy examination on ground of sudden death. He was reported to have headaches over a long period of time. On autopsy examination, massive sub-arachnoid hemorrhage was seen on both the cerebral hemispheres and cerebellum. A cyst measuring about 1 cm diameter was found in choroid plexus of right lateral ventricle. On histopathological examination, it was found to be a choroid plexus papilloma. Calcification was also evident in the papilloma. From medico-legal aspect, the present case reveals an unusual cause for sudden death in an adult male. The pathology could have been diagnosed easily by CT scan or MRI. When diagnosed, it has good survival rate, the morbidity depending on the extent of pathological effects. The present case was likely to have survived having minimal effects with appropriate treatment had he been diagnosed. The pathology is rare and a suspicion for this pathology in the adult male was not expected, but a CT scan to investigate chronic headache was warranted. Absence of such a suggestion leading to death, which could have been preventable, is sufficient ground for charge of professional negligence.