A Case Report and Literature Review

Meningiomas are the most common primary benign tumors of the central nervous system. Their incidence of incidental discovery during forensic autopsy is estimated to be between 2% and 3% of cases. They are tumors with slow and often silent clinical progression, which can cause sudden death due to intracranial hypertension or cerebral herniation. We report a case of a giant parasagittal meningioma discovered incidentally during autopsy in a 36-year-old woman who died following acute headaches. Case Report : A 36-year-old woman with no known significant medical history was found dead at her home. According to statements from those close to her, the deceased complained of acute headaches without other symptoms. A forensic autopsy was ordered. The external examination revealed no external signs of violence or trauma. At necropsy, the heart weighed 200 g, and no abnormalities were observed in the coronary arteries or myocardium. The lungs were congested and edematous. Examination of the other abdominal organs revealed no particular lesions. The brain weighed 1150 g, and in the right frontal lobe was a large, well-defined, fleshy, reddish-brown extra-axial tumor measuring 7 × 6 cm, attached to the dura mater, with a major mass effect on the adjacent cerebral parenchyma and obliteration of the cortical sulci with diffuse cerebral edema. Histology of the brain tumor confirmed the diagnosis of grade 1 angiomatous meningioma. Immunohistochemical analysis showed diffuse positivity of the tumor cells for EMA, CD34, and the progesterone receptor, and negativity for inhibin, GFAP, and CD56. The cause of death was determined to be cerebral herniation due to intracranial hypertension secondary to an angiomatous meningioma. Conclusion : Incident meningiomas are frequently found at autopsy but only exceptionally become fatal when they exceed 4 cm. Our case highlights three points: the possibility of occurrence in young individuals, the importance of acute headaches as a warning sign, and the necessity of a systematic and rigorous neuropathological examination in forensic medicine.