A 51-year-old man with sudden unexpected death

Area of Science:

• Neuropathology
• Neurovascular Medicine

Background:

• Choroid plexus xanthogranulomas are rare, benign tumors typically found incidentally.
• Hemorrhage from these lesions is exceptionally uncommon, with no prior reports linking them to fatal intraventricular or subarachnoid bleeding.

Observation:

• An autopsy was performed on a 51-year-old male found deceased, revealing diffuse subarachnoid hemorrhage at the brain's base.
• Hemorrhage was noted within the left lateral ventricle and adjacent choroid plexus.
• Microscopic examination identified a xanthogranuloma with chronic inflammation, cholesterol clefts, and calcifications within the choroid plexus.

Findings:

• The cause of death was attributed to acute hemorrhage originating from a choroid plexus xanthogranuloma.
• The hemorrhage extended into the intraventricular and subarachnoid spaces.
• Histopathology confirmed features of both recent and remote bleeding within the lesion and surrounding brain tissue.

Implications:

• This case expands the differential diagnosis for sudden, unexpected intracranial hemorrhage.
• It underscores the potential for rare lesions to cause catastrophic vascular events.
• Further investigation into the vascularity and rupture potential of choroid plexus xanthogranulomas may be warranted.