Sudden Death From Ruptured Choroid Plexus Arteriovenous Malformation

Abstract

Brain vascular malformations are recognized as having potential to produce hemorrhage, but leading to sudden death in children is uncommon. Arteriovenous malformations may be situated in any region of the brain, but very rarely, they can be restricted to the choroid plexus. We report here a rare case of sudden death in a child, caused by a ruptured vascular malformation with an unusual location, which was not identified grossly but only on histological examination. The size and the location of the lesion, as well as the age of our patient, were contributing factors of the massive bleeding. Autopsy remains an important tool because it provides valuable information about the etiology of such bleedings, improves knowledge about these lesions, and enhances epidemiologic data.

Inflammation in acquired hydrocephalus: pathogenic mechanisms and therapeutic targets

“…PHH is also a common cause of hydrocephalus in adults 14,18,19 , in whom the condition is often associated with intraventricular haemorrhage resulting from hypertension, aneurysm rupture, or traumatic brain injury. 20 PIH is the most common cause of pediatric hydrocephalus worldwide 5 and is most prevalent in Africa, Latin America and Southeast Asia 8 . As mentioned above, in resource-poor countries, PIH is more common that PHH.…”

Multidisciplinary Approach to Suspected Sudden Death Caused by Arteriovenous Malformation Rupture: A Case Report

“…A particular case report showed a sudden death in a kid, caused by a broken vascular malformation with an uncommon site, not recognized macroscopically but only on histological investigation [ 27 ]. In this case, an MPCT scan did not show the AVM, highlighting the crucial role of autopsy in this kind of death.…”

Central Nervous System Causes of Sudden Unexpected Death: A Comprehensive Review

“…Vascular malformations constitute one of the causes of intracerebral hemorrhage among others including brain neoplasms, coagulopathies, and cerebral and venous sinus thrombosis [6]. Arteriovenous malformations (AVMs) of the brain are abnormal vascular anomalies in which a connection exists between the feeding arteries and draining veins of the brain linked by an interspersed abnormal intervening capillary bed -known as a central nidus [7][8]. Clinically, brain AVMs are a well-known cause of death, mostly due to the resulting intracerebral hemorrhage; however; they can remain asymptomatic for a very long time [8].…”

“…In the pediatric age, ruptured AVMs are considered a rare cause of sudden unexpected death. Cioca et al report an exceedingly rare case of sudden non-traumatic death in a previously healthy nine-year-old boy due to a ruptured AVM of the choroid plexus of the fourth ventricle [7]. Another case by Racette et al reported the sudden non-traumatic death of a 14-year-old girl who was previously well, except for mild asthma [9].…”

“…It is noteworthy that very small malformations may not be evident on imaging or gross autopsy examination but rather found on histological examination. Therefore, it is recommended that forensic pathologists take numerous sections from hemorrhagic areas, including adjacent brain parenchyma and the choroid plexus [7,12].…”