Homicide versus Hypothermia? An Unusual Case of Hypothermia Related to Colloid Cyst of the Third Ventricle

Forensic pathologists and death investigators are well aware of the fact that careful and detailed death investigation and autopsy are essential for identifying certain homicides, wherein initial scene and circumstances incorrectly suggest a probable natural or other non-homicidal manner of death. In a similar way, death investigation and autopsy can be instrumental in dispelling suspicions of homicide, where initial scene and circumstances suggest foul play. The discovery of the partially nude body of an elderly woman, hidden in the exterior entrance to a home's crawlspace, should raise concern of a possible homicide with associated sexual assault. A case occurring in this fashion is presented. Autopsy revealed evidence of hypothermia, including gastric Wishnewsky spots. Brain examination revealed a colloid cyst of the third ventricle, with associated features of increased intracranial pressure. Based on scene investigation and autopsy findings, it was theorized that the woman likely experienced confusion related to her underlying brain lesion, followed by the onset of hypothermia, with subsequent demonstration of the “hide and die” syndrome, as well as paradoxical undressing. The case reiterates the importance of careful investigation and autopsy performance in cases that are suspicious for homicide. Additionally, the case represents a unique presentation of a colloid cyst of the third ventricle, a lesion that is familiar to forensic pathologists.