title: Death from undiagnosed glioblastoma multiforme and toxic self-medication presenting with concurrent dysfunctional behavior.
abstract: We encountered a decedent with an unexpected glioblastoma multiforme. A 61-year-old retired African-American woman was found dead in her home, fully clothed in her bathtub, with a pillow under her head. At autopsy, the brain showed a glioblastoma multiforme. Toxicology showed elevated hydrocodone, propoxyphene, acetaminophen, and positive paroxetine. The presence of a brain tumor likely caused a severe headache. The use of her medications could have indicated a reaction to the escalating pain of the brain trauma, and overuse could be consistent with escalating pain or loss of rational thought processes. The present case is interesting in that it had evidence of behavioral dysfunction that could be related to the brain tumor, and death arising from the glioblastoma multiforme (cerebral hemorrhage and edema) with concurrent multiple drug intoxication.
authors.affiliation: Staff Pathologist, Weland Clinical Laboratories, 1911 1st Avenue SE, Cedar Rapids, IA 52406, USA. hjcmd@earthlink.net
authors.forename: Henry J
authors.initials: HJ
authors.lastname: Carson
authors.forename: Stanley G
authors.initials: SG
authors.lastname: Eilers
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects / Q000032:analysis; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000032:analysis; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000032:analysis; D001929:Brain Edema / Q000209:etiology / Q000473:pathology; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology*; D011431:Dextropropoxyphene / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives / Q000032:analysis; D005260:Female; D049429:Forensic Pathology; D053593:Forensic Toxicology; D005909:Glioblastoma / Q000150:complications / Q000473:pathology*; D051271:Headache Disorders, Secondary / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D006853:Hydrocodone / Q000008:administration & dosage / Q000009:adverse effects / Q000032:analysis; D020300:Intracranial Hemorrhages / Q000209:etiology / Q000473:pathology; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D017374:Paroxetine / Q000008:administration & dosage / Q000009:adverse effects / Q000032:analysis; D012651:Self Medication / Q000009:adverse effects*; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000032:analysis; D014822:Vitreous Body / Q000737:chemistry
chemical_list: D000082:Acetaminophen; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D011431:Dextropropoxyphene; D006853:Hydrocodone; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; C002756:norpropoxyphene