Fire Fatalities and Deaths from Burns in Denmark in 1980

DISCUSSION Colloid cysts are usually situated in the anterior part of the third ventricle and are thought to be a malformation (rather than neoplasm) arising from the paraphysis, a structure seen in the embryo, ependymal pouches, or from the choroid plexus itself. They are rare and almost always present in adult life. There is an equal sex incidence. Symptoms characteristic of the condition are an intermittent and severe headache of sudden onset and often of equally rapid resolution. These are thought to be the consequences of acute obstruction ofCSF drainage due to a 'ballvalve' effect. A colloid cyst usually grows slowly and the clinical history tends to be protracted and intermittent. This is a tragic case. The rarity of the condition and its clinical features must have been a factor in the failure of ante-mortem diagnosis. In this case the cyst would appear to have ruptured or the vessels and tissues about it become damaged. This led to the formation of a mass consisting of cyst material and blood clot, which possibly was enlarged by the process of osmosis common to many intracranial lesions surrounded by cerebro-spinal fluid. In a series of 10,995 consecutive deaths (Di Maio et al., 1980) 19 were found to be due to primary unsuspected intracranial 'neoplasms'. Only one of these cases involved a colloid cyst, and in this case the cyst proved fatal by enlargement, rather than by such catastrophes as rupture and haemorrhage. The history and findings make it difficult to escape the conclusion that following vigorous voluntary shaking of the head, a usually benign and slowly enlarging lesion, either by rupture or by surrounding tissue damage (or both) became rapidly fatal. If this is true, then not only those with colloid cysts, but anyone suffering from an intracranial abnormality which is asymptomatic and undetected, is at risk if indulging in this form of pop music appreciation. Vigorous motion of the head is a recognized cause of fatality in the 'battered baby syndrome'. However, sporting activities such as boxing, judo, wrestling and rugby football produce few such deaths. Those deaths which do occur are usually due to vascular abnormality and in terms of geography and time, widely distributed. It would seem there is a need for some reference centre to which such cases could be referred for purpose of collation.