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Korean J Leg Med > Volume 39(3); 2015 > Article
Korean Journal of Legal Medicine 2015;39(3):67-72.
DOI: https://doi.org/10.7580/kjlm.2015.39.3.67    Published online August 31, 2015.
Determining the Cause of Natural Death: A Case of Previously Unknown Sturge-Weber Syndrome.
Moon Young Kim, Hanna Kim, Sohyung Park, Kyungmoo Yang, Sung Hye Park, Soong Deok Lee
1Department of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea. sdlee@snu.ac.kr
2Medical Examiner's Office, National Forensic Service, Wonju, Korea.
3Department of Pathology, Seoul National University College of Medicine, Seoul, Koreas.
4Institute of Forensic Science, Seoul National University College of Medicine, Seoul, Korea.
Abstract
In some cases, it is difficult to determine a single cause of death even after conducting full autopsy and additional tests. A 49-year-old man, reportedly having diabetes mellitus, was found unconscious by his mother and revealed to be dead. He had several contusions all over his body, including the right periocular area, but they did not appear fatal. A focal area of polymicrogyria and cortical dysplasia was found on the right preoccipital notch, accompanied with dystrophic calcification and leptomeningeal angiomatosis. These findings were considered indicative of Sturge-Weber syndrome, a rare neurocutaneous disorder, of atypical type without facial lesions. Blood level of beta-hydroxybutyrate was 859 microg/mL, implying that he also had diabetic ketoacidosis. His ketoacidosis may not have been corrected appropriately because of status epilepticus in association with brain lesion, resulting in his death, but neither direct evidence nor statement was obtained. In cases with several apparent causes of death, the examiner's assumption should be based not on imagination but on evidence, and logic should not be overlooked. It is more helpful for the investigators or the bereaved to obtain more detailed information rather than come to a hasty conclusion.
Key Words: Cause of death, Sturge-Weber syndrome, Diabetic ketoacidosis, Beta-hydroxybutyrate


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