Sudden Unexpected Death Due to Undiagnosed Pilocytic Astrocytoma

Pilocytic astrocytomas are slow-growing neuroepithelial tumors most commonly found in children, with favorable prognoses. Prognosis is less favorable in the rare adult case in which survival rates decrease with age. Because of the rarity of these tumors in adults, undiagnosed pilocytic astrocytomas causing sudden death are hardly ever encountered in the forensic autopsy setting. The San Francisco Office of the Chief Medical Examiner was presented with a 27-year-old female patient with unknown medical history and recent complaints of nausea and vomiting. Postmortem computed tomography revealed a well-demarcated heterogeneous right cerebellar cystic mass. The autopsy showed an edematous brain with hydrocephalus and fourth ventricular compression, due to a heterogeneous mass found in the right cerebellum. Histopathological examination of the mass revealed findings consistent with the microscopic diagnosis of pilocytic astrocytoma. This case highlights one example of an adult patient with untreated pilocytic astrocytoma in which obstructive hydrocephalus ultimately resulted in death, and discusses the advantages of utilizing post-mortem computed tomography in addition to autopsy.