Unexpected sudden death due to intracranial chordoma: an autopsy case

Intracranial chordoma is a locally invasive, relatively rare tumour at the base of the skull. The tumour usually grows slowly but there have been several case reports of sudden death, all of which were due to tumour-associated haemorrhages. We report an autopsy case of a sudden unexpected death due to clinically undiagnosed intracranial chordoma in the brainstem without haemorrhage. A 44-year-old man was found dead at home. The autopsy revealed two small gelatinous and semi-translucent greyish tumours on the ventral surface of the brainstem between the midbrain and pons. The tumours were not attached to the dura or bone. The brain was markedly swollen, with enlarged lateral and third ventricles, but the aqueduct was compressed and narrowed. Microscopically, the tumour invaded the cerebral peduncles, and was classified as a chordoma. The cause of death was diagnosed as acute obstructive hydrocephalus due to a ventral brainstem tumour. Even a minor intracranial tumour that is not primarily life-threatening may cause sudden death due to subsequent obstructive hydrocephalus. The brainstem is one of the most vulnerable regions in the brain, and careful examination of this region is important for forensic pathologists.