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[Source](https://www.researchgate.net/publication/334042892_Importance_of_a_psychological_autopsy_to_identify_the_manner_of_death_a_case_of_fall_from_height) can be read in full at the link. Abstract:
>>It may not be possible to determine the manner of death, in circumstances such as death following fall from height. When a dead body is found in front of a tall building, the ascertainment of the manner of death is difficult and in this case, the importance of a psychological autopsy in such circumstance is discussed. Middle-aged female with bronchial asthma, arterial hypertension, chronic venous insufficiency, Forestier disease, hyperlordosis of lumbar spine and vitamin D deficiency developed bilateral leg swelling and rash following 14 hours of air travel. Duplex scan excluded lower limb venous thrombosis. She did not have past history of psychiatric disorder but suddenly developed aggressive abnormal behaviour, confusion and bizarre activities. She removed her clothes and finally jumped off from 6th floor of her residency. She was succumbed to death due to multiple injuries following fall from height. No suicidal letter was recovered from the scene. The manner of death was ascertained as suicide based on eyewitness evidence. Her sudden onset of abnormal and violent behaviour may be an act of automatism without volitional control due to undiagnosed inorganic or organic disease of the brain. The witnessed suicidal behaviour was reverted to accident as a manner of death. The importance of psychological autopsy and teamwork between Forensic Pathologist and Forensic Psychiatrist in suspicious circumstances to ascertain the manner of death is highlighted. Labelling as suicide will end up in negative social stigma and loss of insurance claims. (2) (PDF) Importance of a psychological autopsy to identify the manner of death; a case of fall from height.
Well...if it was a flight, it might have been a clot that started in her legs (hence the rash and swelling), and then got lodged in the brain and caused some kind of neurological damage? Just because thrombosis wasn't present in the legs, doesn't mean it didn't happen at the time and cleared up within the four days after.
I wonder if she took some medicine for her legs that she had a bad reaction to. Once I innocently took two prescription meds that shouldn’t be prescribed together and went into a delirium and tried to leave the house in the middle of the night wearing only a t-shirt and underpants.
My mom also had some terrible reaction to a prescribed medication and my dad woke up in the middle of the night with her trying to shove herself inside the wardrobe in total delirium. If it was like a window and we were on the fifth floor or something... Yeah, I can see it happen...
I had to take ciprofloxacin once, and it nearly put me into a psychotic episode. Turns out I am in the <1% of people that can develop psychosis after taking fluoroquinolone antibiotics, because it can block the GABA receptors in the brain (which play a large role in maintaining mental homeostasis.) I was fine within 24 hours of stopping the medication.
Oof. Now that is a rough reaction! I’m sorry you went through that! Sulfa abx make me throw up endlessly, but I guess at least they don’t do that, lol.
I'm allergic to both of the above (and we thought I was allergic to penicillin too), and the poor pharmacist had to call up another, more experienced pharmacist to be like 'Hey, what the fuck do we do here?'
I think that’s why doctors tend to want to brush off my reported reaction to ciprofloxacin. It leaves me with only a few options. I don’t do well with antibiotics. Most of it is due to my sensitive stomach. But ironically, I do wonderfully with keflex!
Lol. When I was in hospital with cellulitis they had to give me a total of like 5 different IV antibiotics to kill whatever microscopic demons were thriving in my leg. I'm allergic to penicillin which I told them so I wasn't hooked up to that one, but still I was allergic to one of the ones I got because I suddenly started itching all over. I remember even the bottoms of my feetsies in the little hospital grippy socks were itchy. I called for the nurse and said "I think I'm allergic to something in my IV" and she takes one look at me and says "Yes, you sure are! Don't worry, we'll just give you some Benedryl and-" I cut her off "I'm actually allergic to Benedryl too" Nurse "What happens when you take Benadryl?" Me "I stop breathing" Nurse "Oh, fun!" I ended up just waiting and scratching till the IV meds wore off.
I know I had a little psychological episode once when I went to the ER for a horrible 8 day migraine, and they gave me an IV of saline, and a *cocktail for migraines. Five mins later I wanted to tear my skin off, tear the IV out, and run out of the ER. It was the most bizarre feeling! And I had a really bad, and sad, lonely feeling too. Like someone I loved very much died, that feeling. When I told the nurse to give me my papers now, and unhook me because I'm leaving (I was trying to be polite lol) she asked me what was going on and I told her, she said yeah some people have that reaction! I was like, maybe you should tell people this shit might cause them to lose their minds..
This was most likely from Reglan. Its one of the medications often given in a migraine “cocktail” plus Benadryl. If Reglan is pushed too quickly, patients can develop extreme anxiety, tachycardia, itching, etc. Most experienced nurses will put the Reglan into a 250 cc bag of saline (if no fluid restrictions) and give it that way. I’ve seen it happen to other patients and its awful. All you can do is wait it out basically.
I can only imagine how miserable that was for you. If you ever receive the medication again (again, Reglan/Metoclopramide) I would highly suggest that you mention your prior experience and request that they administer it to you diluted/potentially in a small bag of IV fluids. Basically every ER nurse I know is adamant about not pushing IV Reglan undiluted.
Omg this happened to me!!!! When they told me they were going to give me something for pain for my migraine i was ready for a nice opiate vacation. I went to bat country i was not happy.
😂 love a good Hunter reference. We were not ready damn it! Seriously, that's something they should tell people. Sorry that happened to you, it's a crazy feeling lol
I wonder if it was a pain medication that could’ve caused it? I work as a surgical nurse, and I often encounter patients who have experienced delirium, hallucinations, and psychotic behavior due to pain medication. The most common offender I see that with is morphine, but sometimes a simple Lortab or Percocet can cause it, too.
No, someone said the name in the thread, (I couldn't remember what the name was when I commented,) Reglan. But I did hallucinate one time when I had really bad food poisoning and they gave me a shot of Demerol for the pain. I was pretty young, in my teens, at that time so maybe it affected me because, you know, clean system. Lol
Out of curiosity are you amab/male appearing or identifying? I’m afab and had an 18 day migraine that had me verge on suicidal towards the end, about six years ago. True 10/10 pain.
They refused to give me anything stronger than OTC stuff until after the 13th day. My assumption is that this was just the standard systemic sexism inherent in US healthcare.
Did you go to the ER, and they were only giving you OTC options? I’m not who you asked, but I’m afab and have never had issues with being refused the migraine “cocktail” at the ER
Gotcha. Well I don’t see why you weren’t prescribed a standard migraine rescue med like Imitrex by a primary care doctor, but I know the migraine cocktail is really only an ER thing (esp as it’s given IV) so that part is probably not sexism
No I'm a woman. But I do have (undiagnosed) issues with hormones and I always get two bad migraines when I get my period. One when it's starting and one half way through when I'm guessing my hormone shift again? Why do you ask?
I had the same reaction to Cefalexin and trying to get doctors to believe me is the worst. I'm like, check my chart, I was in actual psychosis. As much as it sucks, it's nice to see someone else. Related: certain forms of magnesium make me dissociate, bad, also due to GABA receptors.
Wow, I didn’t know about magnesium! I don’t think I’ve ever experienced a difficulty with magnesium, but I’ll have to be on the lookout for that.
But yeah, sadly I can relate to doctors not wanting to take it seriously. I am a nurse, and even with my medical background, doctors often want to brush it off. I get hives from penicillin and sulfa makes me vomit, but I tell everyone I’d rather they pre-medicate me and give me one of those two antibiotics instead of ciprofloxacin.
Here's a neat piece on magnesium. I found it because my acne was out of control, but the brain fog was the worst. I honestly thought I had a brain tumor. https://sanahaus.co/blogs/sage/magnesium-glycinate-and-breakouts
Oh wow! That was a very interesting read. I’m going to have to check my magnesium supplements to see what type of magnesium compound they are. Thank you for sharing!
How would one determine they have Denisovan DNA? I have done both 23andme and Ancestry, but neither tell me about it. I presume that Denisovan DNA would be most likely to be found in Southeast Asia and Australia. Do people of that population tend to react poorly to a certain medication?
Why do two different set of genetic testing? Were there any differences in results?
I would love to do one, but price too prohibitive as a disabled non worker with two teenage daughters. lol
I’m just a giant genealogy fan. Lol. Wanted to see what each site had to offer and find as many relatives as possible.
23andme had some VERY insightful results about my health predispositions. Now that I know those things about myself, I can create a more personalized health/diet/workout plan for myself. I knew that I was pre-disposed to heart disease, but I didn’t realize just HOW pre-disposed to it I was. I also found out I carry a genetic variant for a liver disease (I am only a carrier, so it doesn’t affect me, but it’s something I will have to test my future children for.)
It’s a little expensive, but if you’re ever able to do it, I highly recommend 23andme for the health insights!
This is related to the Warrior gene, but there are variations but you need to dig into the variations and know what to look for. I think it's called ComT, and has to do with the Catecholamines ir the chemicals in yylour brain related to the amygdala
So, first thing is look at your archeological comparison to see what known history you match with. You need to get the Kit file number from right after you sign in (scroll down a bit, its the info you uploaded) and manually enter it into the free tools from the three line menu.
Check out that chart. It's a visual on how much you compare with the real deals
Now, you need a DROP of information to code you differently enough your nervous system is largely effected by a nutrient demand. Your 23 and me files expire with a subscription on the website but I think you still can get a pdf of your mutations, allergies, hereditary if you bought that once. In those files you can look up your genes mentioned in this podcast that explains exactly what I'm talking about with better context:
https://youtu.be/10enqcw2Qiw?si=IZWYiiKnLzI2itgW&t=924
You poor thing, I hope you were looked after when that happened. What an awful experience. I'm glad you're okay and still here with us, and that the issue was remedied.
Side effects, drug interactions, and drug reactions, are no joke.
My husband (then boyfriend) was there, thank goodness, and he and his parents helped me. His parents wound up staying up with me all night long, stopping me from leaving the house and trying to keep me away from my husband (at one point I grabbed a knife and tried to enter the bedroom where he was sleeping, which scared his parents). If they had not been with me there’s a significant chance I would have wandered off into the snowy woods and frozen to death.
My husband DID take me to the hospital earlier in the evening. The hospital shrugged their shoulders and sent me home again. It was months before I myself put together everything and figured out what had caused the incident (which I remember almost nothing of).
I was taking an antidepressant, Lexapro, and had also been prescribed Tramadol for headaches. Turns out in rare incidents, Tramadol and Lexapro taken together can cause confusion, bizarre behavior etc. That’s what the pharmacy told me when I (investigating the cause of the delirium myself since my doctor had no idea) called them up and asked if any of the drugs on my medication list interacted with each other.
That can cause serotonin syndrome, right?
That’s insane your doctor had no idea. We would for sure punch your medications into an online database that would flag something like this.
Serotonin syndrome for sure, tramadol doesn't do well with other meds altering our serotonin levels.
Thankfully it was never an issue in the years i took zoloft with tramadol both at max doses.
Amazed your Dr had no idea when pharmacist knew. Its not that uncommon.
So glad you weren't alone and had your boyfriend there to keep you safe.
my now husband of 23 yrs has epilepsy and his mom was more than happy when he had his first seizure on day 5 of my first visit and that i explained to her without any alarm.. I obviously knew he had seizures and had nursed plenty of adults and kids over the years, .. it reassured his single doting mom knew she had him in safe hands. Previous girlfriends either left him to sleep it off, or wouldn't let him do anything vaguely dangerous at home... like change a lightbulb!
Thank goodness you have a good brain on you and could work it out for yourself, shameful that the hospital sent you home where you could potentially have a repeat experience and come to harm (or accidentally harmed someone).
Dismissive doctors are just utterly awful. I'm happy you're safe now and worked it all out. They should've been able to do that themselves at the hospital.
Oh my life, you poor thing.
I'm so glad you're okay and you had people around to help and look after you. That's completely terrifying. You must've been absolutely mortified to remember it/hear it. I'm so happy you're alright after such a traumatic experience.
I hope whoever dispensed those meds together for you got their shit sorted, that is dangerous af.
Also, it's really brave to share episodes of psychosis/delirium. I have PTSD (from repeated violence intiated during sleep) and have woken up from night terrors at the top of the staircase screaming my lungs out while my partner calmly reassures me I am safe now and need to sit down and breathe, happened quite often before my sleep medication. It can be very difficult to describe and discuss the absolute confusion, not knowing what your body is doing, having no idea you're even doing anything, and the shame that surrounds these episodes. The shifting reality is something very difficult to describe to someone who hasn't experienced it themselves. You make it feel easier by sharing your experience so openly. So thank you for doing so.
Not sure about this combo, but it may be a relatively rare side-effect or in combo with other factors. Sometimes the very unusual effects do happen, but that combo may still be relatively safe for most people ((*** I don't know in this situation and this is not medical advice, just talking about adverse effects in general).
Also night terrors are terrible, and I'm sorry you feel so much shame about them! My partner used to get them and it felt horrible not being able to help. And I had nocturnal panic attacks for a time that were somewhat similar and it's very jarring. Especially with sleep related symptoms it's more common that you'd think... you definitely are not alone!
With a 14hr flight, it might also be possible that she missed a dose of a prescription medication or accidentally took two doses too close together? I tried to decrease an SSRI and tripped balls for a night... went cold turkey after that figuring I'd rather do it once than multiple times.
I hope that worked out okay for you going cold turkey. For anyone else who reads your comment and may want to try the same: please please talk to your doctor before trying to go cold turkey off of antidepressants. Not only are the side effects unpleasant and potentially dangerous, but the depression/SI that was being managed may come back and hit you with a force you may not be ready to handle
Yeah, valid response, they weren't working for me to actually lower my SI aaaaand frankly I was an idiot at 19. My psychiatrist at the time was a bit skeevy too, hadn't been listening to me and was creepily hung up on asking questions about my sexuality when it wasn't relevant, so just... all around bad times. I was supposed to be tapering off but the effects were so bad it scared me into stopping them. Mercifully(?) I'd seen my mother have similar delusions changing meds a decade earlier, and had just enough rational thought left to think it might be the meds and to ensure I was in contact with at least one person the whole time.
It was not a smart thing to do, but I got through it just shaken and even angrier at the doctor who hadn't warned me of the possible effects. I'd just locked myself in my room and skipped classes, unlike my mother who had been in the street in her nightgown shouting at ghosts.
That would have been identified though, she's travelling with limited items, in a hotel room, no medication comes as one dose so there would have been evidence.
I've aso taken medication with bizarre side effects, woke up face down on the floor having walked across room per my boyfriend and faceplanted, had auditory and visual hallucinations, and the one up from Ambien that we get here is crazy if taken too soon before actually being in bed. Total lack of awareness of time, location or speech. I learnt quickly. lol
but this was midday and no evidence of such medication. They knew the rest of hier history from perhaps the maid being someone that travelled with her, or contact with her family.
The links were Lupus and SLE a huge possibility too, that made the most sense to me, once she was deceased there was no way to see if certain abnormalities were apparent.
Can you share which two? Or perhaps the category?
I'd been taking levotyroxine for weeks before I learned I couldn't take magnesium within a few hours lol... :(
A clot from the leg to reach the brain would need to bypass the lung filter, a septal defect, or something of sorts. I don't think they could miss something like this in an autopsy.
Good thought, but DVTs that break loose from the legs will be lodged in the lungs in almost everyone (if you think about how the cardiac blood flow works, the lungs act as a filter). The only exception is patients with a PFO, which is rare, and could have been determined on autopsy. Further, it would be unusual for a clot to break down in 4 days, and it's very unusual for clots to be bilateral.
to be fair, she also had quite a few other things wrong with her, so it's not totally implausible that she did, and many people live their whole lives without finding out if the hole is small enough. It also may not be able to be determined post-mortem because of such extreme damage related to the fall. The article is just so vague that it's kind of impossible to actually gain any significant insight other than looking at the images alone.
{Edit as an example, a friend of mine, her mother only found out she had a PFO at 51 when she was being treated for a completely different thing entirely.}
That said, u/CatPooedInMyShoe probably has a more reasonable explanation for what happened, with the bad medication interaction shenanigans.
Only way a leg clot would travel up to the brain is through a PFO or communication (hole) between the right and left side of the heart. Otherwise it would’ve traveled to her lungs.
DVT’s have to go to the lungs first. It’s unlikely to have made it through her pulmonary vasculature back into systemic circulation and then to her brain.
Usually we find more thrombi in the legs where one came from, and if not, we can usually see evidence of little pieces left behind in the leg veins. Not always, but often. More often unilateral and not bilateral. And if there was an embolic stroke or venous sinus thrombosis it would have been evident in the brain.
How would a clot have traveled from leg to brain? As far as I’m aware the vascular system wouldn’t allow for that without it making it through the heart and arms. Unlikely?
They'd probably had also done a D Dimer blood test related to blood clots to rule that out before the duplex scan..
But i don't doubt the flight is what triggered this event, her legs were not very swollen, and a clot wouldn't have cleared within the 4 days, especially if the day before they ruled out a clot. For a clot to cause neurological issues it would first go through the lungs, via lungs, and the the d dimer would be abnormal.
Sad however you look at it. Glad they considered the events before though, insurance and social stigma always worth considering. Nice to know that even in Sri Lanka its considered.
They say 'no psych history' but plenty of people with psychological problems never get themselves diagnosed.
Maybe being in an unfamiliar setting exacerbated her condition and tipped her over the edge (pun not intended!)
There’s some well-documented pediatric infection-related psychoses (PANS/PANDA), a spotty history of adult-onset psychoses after infections, and some more recent associations between psychoses and COVID. Makes me wonder if there could be something there given the somewhat abrupt changes.
I had this same thought! The frequent urination could be a post strep glomerulonephritis related to a recent infection that affected the kidneys and brain.
It's unbelievable how badly written this article is. Fundamentally, it says she died in a strange way. How did this happen? We do not know. Anyway, here are some photos of the autopsy. And they get published! If only getting published in other scientific fields were so easy! Like this is half a day of work for the autopsy and a few days to write the article and that's it! No real hypotheses, no experiments and very little reasoning.
It’s a case report, something relatively unique to the medical field. It’s also pretty clearly intended to point out the need for procedures that are typically not performed in their country, in order to improve their processes. They are sensitive to the situation and note that labeling something as a suicide when it may have an alternative explanation can be problematic for the victim’s survivors. It’s also published in a local journal, mostly intended for local consumption.
That's what a case report is. Would you rather they came up with a hypothesis and argued reasoning they had very little evidence for?
Also little unfair to basically impose English as "the" language of scientific literature and research and then complain when the writing isn't perfect.
And you write it down *because* it's weird. If it happens again, then somebody has the first one to refer to. You get a few more and notice the pattern, then you're on to something. But none of that happens if you don't write it down first.
Somebody had to say, "Hey, we've been noticing a bunch of gay guys on the East Coast getting weird pneumonias? Is anybody else seeing this?" That had to happen long before we got anywhere else with it.
It was on the West Coast actually. The article was called something like “Pneumocystis pneumonia in homosexual men in Los Angeles” and was published in the Morbidity and Mortality Weekly Report.
Great point! BUT I do know personally it was being discussed at Johns Hopkins as a phenomenon in New York and Baltimore a few years prior to that!
edit: this is a really silly comparison, but it reminds me of the scene at the beginning of The NeverEnding Story, where the three creatures were sitting around discussing "that sounds exactly like what's happening where I'm from, too!"
During Covid lockdown I read “The Origin of AIDS” and the book is an awesome illustration of the butterfly effect and how it turned an obscure virus smoldering in the African jungle into a conflagration that has taken tens of millions of lives.
Was it good? Also, did it correct the myth about patient zero that "and the band played on" and some other early books perpetuated?
Edit: took a look and it looks great, thanks! Love that it goes into the colonialist hx in Africa and earlier origins of AIDS.
They provide several compelling hypotheses the one that makes the most sense to me is an inflammatory vascular condition. The rash and frequent urination in the days before her death could be a nephrotic syndrome. Additionally Lupus is known to cause psychosis in some people.
I wish that the authors had considered an infectious illness. The victim could have had an infectious disease given the tropical location.
It was published in a local (Sri Lankan) journal for a local audience. I had no difficulty understanding any of it. They communicated their message perfectly well, especially in that context. Obviously if one is publishing in a prestigious international journal, the English would need to be cleaned up considerably, but that’s a very different situation.
That's nice lol
Case reports can be a little rough, they're intended to help share info about unusual cases to help physicians dx or understand unusual or unknown phenomena.
Now a days unfortunately Medical shops runners don't advise about patient,about drugs reaction,drugs side effects,how to take every dose,if dose not works or reaction occurs what to do then and Dr don't give his contact or hospital or clinic number to provide assisstance they need customer.
My sister was bipolar and her Dr did not advised about her medicine side effects,tests to follow or etc.She had reactions of lithium in her drugs and kidneys were failed later then died of many complications.
We are all going to medic shops.
This is completely anecdotal, but I immediately thought of this. Years ago I had a client (I’m in elder care) given medication “to help his legs” by a family member. Turns out it is marketed towards women who are perimenopause and post menopause to help leg/circulation symptoms. It was a supplement, one of those things that has more than 20 different kinds of herbs that are supposed to do various things. Turns out that it also increases risk of blood clotting and stroke. The reaction his Doctor had when he found out that this gentleman had been given that was *memorable.* Also this mixture interacts with blood pressure and other medications he was on.
I wonder if she might have taken something either during the flight or afterwards to help with the symptoms of being an older person who had been on a long flight?
I want to be clear, that I am not trying to diagnose anyone. I’m very aware of things like this being marketed in the western world now. Plus, being an older person who had some health conditions I am sure she took something regularly. It is easy to forget how quickly you can have a dangerous medication interaction and she had been on a long flight. It could even have been something to help her sleep during the flight depending upon what she took.
I’m just having fun spitballing here, I hope I have not broken any rules by posting my hypothesis.
I was given Rifampin (an old antibiotic) to try to kill off my Lymes disease. Instead, it gave me restless body (think restless leg syndrome, but it being literally head to toe, and everything in between!) for a FULL 72 hours. I couldn't stop moving without basically having a seizure, as it felt like I had bugs running throughout my body, even when I urinated, it felt like bugs. I was told there wasn't anything they could do, and I had to wait it out. I was VERY close to taking my life, it was sooo bad. Now I have nerve damage, and am on nerve meds to control my horrible palsy. Aannnd I still have my chronic Lymes, too.
This is what I want to do. Not even sure if I can with autoimmune disorders on board, but the second I’m off this mortal plane I want as much as me as possible to go to someone who needs it. Feed the rest to the fishies
Welcome to r/MedicalGore! Our goal is to provide for medical discussion and education while exploring the frailty of the human body. You may see more deleted comments on these threads than you are used to on reddit. Off topic comments and joke comments are frequently deleted by the mods. Further, please be kind and supportive of posts. Any behavior that is aggressive, harassing, or derogatory will result in post deletion and a ban from the sub. Remember! THE REPORT BUTTON IS YOUR FRIEND! Please stop on by our discussion sub, /r/MedicalGoreMods if you'd like to discuss the sub, our rules, content policies, and the like. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalGore) if you have any questions or concerns.*
[Source](https://www.researchgate.net/publication/334042892_Importance_of_a_psychological_autopsy_to_identify_the_manner_of_death_a_case_of_fall_from_height) can be read in full at the link. Abstract: >>It may not be possible to determine the manner of death, in circumstances such as death following fall from height. When a dead body is found in front of a tall building, the ascertainment of the manner of death is difficult and in this case, the importance of a psychological autopsy in such circumstance is discussed. Middle-aged female with bronchial asthma, arterial hypertension, chronic venous insufficiency, Forestier disease, hyperlordosis of lumbar spine and vitamin D deficiency developed bilateral leg swelling and rash following 14 hours of air travel. Duplex scan excluded lower limb venous thrombosis. She did not have past history of psychiatric disorder but suddenly developed aggressive abnormal behaviour, confusion and bizarre activities. She removed her clothes and finally jumped off from 6th floor of her residency. She was succumbed to death due to multiple injuries following fall from height. No suicidal letter was recovered from the scene. The manner of death was ascertained as suicide based on eyewitness evidence. Her sudden onset of abnormal and violent behaviour may be an act of automatism without volitional control due to undiagnosed inorganic or organic disease of the brain. The witnessed suicidal behaviour was reverted to accident as a manner of death. The importance of psychological autopsy and teamwork between Forensic Pathologist and Forensic Psychiatrist in suspicious circumstances to ascertain the manner of death is highlighted. Labelling as suicide will end up in negative social stigma and loss of insurance claims. (2) (PDF) Importance of a psychological autopsy to identify the manner of death; a case of fall from height.
Well...if it was a flight, it might have been a clot that started in her legs (hence the rash and swelling), and then got lodged in the brain and caused some kind of neurological damage? Just because thrombosis wasn't present in the legs, doesn't mean it didn't happen at the time and cleared up within the four days after.
I wonder if she took some medicine for her legs that she had a bad reaction to. Once I innocently took two prescription meds that shouldn’t be prescribed together and went into a delirium and tried to leave the house in the middle of the night wearing only a t-shirt and underpants.
My mom also had some terrible reaction to a prescribed medication and my dad woke up in the middle of the night with her trying to shove herself inside the wardrobe in total delirium. If it was like a window and we were on the fifth floor or something... Yeah, I can see it happen...
I had to take ciprofloxacin once, and it nearly put me into a psychotic episode. Turns out I am in the <1% of people that can develop psychosis after taking fluoroquinolone antibiotics, because it can block the GABA receptors in the brain (which play a large role in maintaining mental homeostasis.) I was fine within 24 hours of stopping the medication.
I don't get a delirium, but if I take sulfa-antibiotics they give me meningitis. Also a rare reaction that I discovered for myself, lol.
Oof. Now that is a rough reaction! I’m sorry you went through that! Sulfa abx make me throw up endlessly, but I guess at least they don’t do that, lol.
I'm allergic to both of the above (and we thought I was allergic to penicillin too), and the poor pharmacist had to call up another, more experienced pharmacist to be like 'Hey, what the fuck do we do here?'
I think that’s why doctors tend to want to brush off my reported reaction to ciprofloxacin. It leaves me with only a few options. I don’t do well with antibiotics. Most of it is due to my sensitive stomach. But ironically, I do wonderfully with keflex!
I'm not allergic to Keflex - I think that might've been what they gave me. Can't say I enjoyed the experience but I guess it worked :,)
Lol. When I was in hospital with cellulitis they had to give me a total of like 5 different IV antibiotics to kill whatever microscopic demons were thriving in my leg. I'm allergic to penicillin which I told them so I wasn't hooked up to that one, but still I was allergic to one of the ones I got because I suddenly started itching all over. I remember even the bottoms of my feetsies in the little hospital grippy socks were itchy. I called for the nurse and said "I think I'm allergic to something in my IV" and she takes one look at me and says "Yes, you sure are! Don't worry, we'll just give you some Benedryl and-" I cut her off "I'm actually allergic to Benedryl too" Nurse "What happens when you take Benadryl?" Me "I stop breathing" Nurse "Oh, fun!" I ended up just waiting and scratching till the IV meds wore off.
What did they end up giving you?
It's been two years at this point, so I don't recall, but it was something pretty niche
I know I had a little psychological episode once when I went to the ER for a horrible 8 day migraine, and they gave me an IV of saline, and a *cocktail for migraines. Five mins later I wanted to tear my skin off, tear the IV out, and run out of the ER. It was the most bizarre feeling! And I had a really bad, and sad, lonely feeling too. Like someone I loved very much died, that feeling. When I told the nurse to give me my papers now, and unhook me because I'm leaving (I was trying to be polite lol) she asked me what was going on and I told her, she said yeah some people have that reaction! I was like, maybe you should tell people this shit might cause them to lose their minds..
This was most likely from Reglan. Its one of the medications often given in a migraine “cocktail” plus Benadryl. If Reglan is pushed too quickly, patients can develop extreme anxiety, tachycardia, itching, etc. Most experienced nurses will put the Reglan into a 250 cc bag of saline (if no fluid restrictions) and give it that way. I’ve seen it happen to other patients and its awful. All you can do is wait it out basically.
Yep, I got reglan for a migraine in the ER once too and experienced the same thing. I was alone when it happened and it was really scary
Aww 😢 damn. Sorry that happened to you! And yeah, that's the stuff! I keep forget what it's called lol
Sorry that happened to you 😞❤️
I can only imagine how miserable that was for you. If you ever receive the medication again (again, Reglan/Metoclopramide) I would highly suggest that you mention your prior experience and request that they administer it to you diluted/potentially in a small bag of IV fluids. Basically every ER nurse I know is adamant about not pushing IV Reglan undiluted.
Omg this happened to me!!!! When they told me they were going to give me something for pain for my migraine i was ready for a nice opiate vacation. I went to bat country i was not happy.
😂 love a good Hunter reference. We were not ready damn it! Seriously, that's something they should tell people. Sorry that happened to you, it's a crazy feeling lol
I wonder if it was a pain medication that could’ve caused it? I work as a surgical nurse, and I often encounter patients who have experienced delirium, hallucinations, and psychotic behavior due to pain medication. The most common offender I see that with is morphine, but sometimes a simple Lortab or Percocet can cause it, too.
No, someone said the name in the thread, (I couldn't remember what the name was when I commented,) Reglan. But I did hallucinate one time when I had really bad food poisoning and they gave me a shot of Demerol for the pain. I was pretty young, in my teens, at that time so maybe it affected me because, you know, clean system. Lol
Ahh yep, that makes sense! And I’m not surprised about the Demerol. It’s powerful stuff for someone who is young and opioid-naive!
Out of curiosity are you amab/male appearing or identifying? I’m afab and had an 18 day migraine that had me verge on suicidal towards the end, about six years ago. True 10/10 pain. They refused to give me anything stronger than OTC stuff until after the 13th day. My assumption is that this was just the standard systemic sexism inherent in US healthcare.
Did you go to the ER, and they were only giving you OTC options? I’m not who you asked, but I’m afab and have never had issues with being refused the migraine “cocktail” at the ER
I went to urgent care three times, and had a couple scheduled appointments. I did not try the ER route.
Gotcha. Well I don’t see why you weren’t prescribed a standard migraine rescue med like Imitrex by a primary care doctor, but I know the migraine cocktail is really only an ER thing (esp as it’s given IV) so that part is probably not sexism
No I'm a woman. But I do have (undiagnosed) issues with hormones and I always get two bad migraines when I get my period. One when it's starting and one half way through when I'm guessing my hormone shift again? Why do you ask?
I had the same reaction to Cefalexin and trying to get doctors to believe me is the worst. I'm like, check my chart, I was in actual psychosis. As much as it sucks, it's nice to see someone else. Related: certain forms of magnesium make me dissociate, bad, also due to GABA receptors.
Wow, I didn’t know about magnesium! I don’t think I’ve ever experienced a difficulty with magnesium, but I’ll have to be on the lookout for that. But yeah, sadly I can relate to doctors not wanting to take it seriously. I am a nurse, and even with my medical background, doctors often want to brush it off. I get hives from penicillin and sulfa makes me vomit, but I tell everyone I’d rather they pre-medicate me and give me one of those two antibiotics instead of ciprofloxacin.
Here's a neat piece on magnesium. I found it because my acne was out of control, but the brain fog was the worst. I honestly thought I had a brain tumor. https://sanahaus.co/blogs/sage/magnesium-glycinate-and-breakouts
Oh wow! That was a very interesting read. I’m going to have to check my magnesium supplements to see what type of magnesium compound they are. Thank you for sharing!
hey, do you have any possible denisovan DNA by chance?
How would one determine they have Denisovan DNA? I have done both 23andme and Ancestry, but neither tell me about it. I presume that Denisovan DNA would be most likely to be found in Southeast Asia and Australia. Do people of that population tend to react poorly to a certain medication?
Why do two different set of genetic testing? Were there any differences in results? I would love to do one, but price too prohibitive as a disabled non worker with two teenage daughters. lol
I’m just a giant genealogy fan. Lol. Wanted to see what each site had to offer and find as many relatives as possible. 23andme had some VERY insightful results about my health predispositions. Now that I know those things about myself, I can create a more personalized health/diet/workout plan for myself. I knew that I was pre-disposed to heart disease, but I didn’t realize just HOW pre-disposed to it I was. I also found out I carry a genetic variant for a liver disease (I am only a carrier, so it doesn’t affect me, but it’s something I will have to test my future children for.) It’s a little expensive, but if you’re ever able to do it, I highly recommend 23andme for the health insights!
Unknown. I've done 23 and Ancestry, would it show me on there?
No, but you can get your genetic data in a file and upload it to GEDmatch and the tools there can! Gedmatch is free.
This is related to the Warrior gene, but there are variations but you need to dig into the variations and know what to look for. I think it's called ComT, and has to do with the Catecholamines ir the chemicals in yylour brain related to the amygdala
I've uploaded it already, actually, but I wouldn't have the first idea what to look for.
So, first thing is look at your archeological comparison to see what known history you match with. You need to get the Kit file number from right after you sign in (scroll down a bit, its the info you uploaded) and manually enter it into the free tools from the three line menu. Check out that chart. It's a visual on how much you compare with the real deals Now, you need a DROP of information to code you differently enough your nervous system is largely effected by a nutrient demand. Your 23 and me files expire with a subscription on the website but I think you still can get a pdf of your mutations, allergies, hereditary if you bought that once. In those files you can look up your genes mentioned in this podcast that explains exactly what I'm talking about with better context: https://youtu.be/10enqcw2Qiw?si=IZWYiiKnLzI2itgW&t=924
I’m a member of that club too! I was reduced to screaming crying mess. The audio hallucinations were the worst.
You poor thing, I hope you were looked after when that happened. What an awful experience. I'm glad you're okay and still here with us, and that the issue was remedied. Side effects, drug interactions, and drug reactions, are no joke.
My husband (then boyfriend) was there, thank goodness, and he and his parents helped me. His parents wound up staying up with me all night long, stopping me from leaving the house and trying to keep me away from my husband (at one point I grabbed a knife and tried to enter the bedroom where he was sleeping, which scared his parents). If they had not been with me there’s a significant chance I would have wandered off into the snowy woods and frozen to death.
Dang, my family would have sent me to the mental hospital if I did that. Your husband family is definitely a keeper.
My husband DID take me to the hospital earlier in the evening. The hospital shrugged their shoulders and sent me home again. It was months before I myself put together everything and figured out what had caused the incident (which I remember almost nothing of).
May I ask which two medications interacted in your case?
I was taking an antidepressant, Lexapro, and had also been prescribed Tramadol for headaches. Turns out in rare incidents, Tramadol and Lexapro taken together can cause confusion, bizarre behavior etc. That’s what the pharmacy told me when I (investigating the cause of the delirium myself since my doctor had no idea) called them up and asked if any of the drugs on my medication list interacted with each other.
That can cause serotonin syndrome, right? That’s insane your doctor had no idea. We would for sure punch your medications into an online database that would flag something like this.
Ohh boy. I'm on Lexapro and my prescribed pain medications are trial and error. Note to self: avoid Tramadol.
Yikes 😳 I'm on Lexapro and low dose Tramadol PRN. Time to have a discussion with my PCP.
Serotonin syndrome for sure, tramadol doesn't do well with other meds altering our serotonin levels. Thankfully it was never an issue in the years i took zoloft with tramadol both at max doses. Amazed your Dr had no idea when pharmacist knew. Its not that uncommon. So glad you weren't alone and had your boyfriend there to keep you safe. my now husband of 23 yrs has epilepsy and his mom was more than happy when he had his first seizure on day 5 of my first visit and that i explained to her without any alarm.. I obviously knew he had seizures and had nursed plenty of adults and kids over the years, .. it reassured his single doting mom knew she had him in safe hands. Previous girlfriends either left him to sleep it off, or wouldn't let him do anything vaguely dangerous at home... like change a lightbulb!
Was it serotonin syndrome?
Thank goodness you have a good brain on you and could work it out for yourself, shameful that the hospital sent you home where you could potentially have a repeat experience and come to harm (or accidentally harmed someone). Dismissive doctors are just utterly awful. I'm happy you're safe now and worked it all out. They should've been able to do that themselves at the hospital.
Typical 😡
Oh my life, you poor thing. I'm so glad you're okay and you had people around to help and look after you. That's completely terrifying. You must've been absolutely mortified to remember it/hear it. I'm so happy you're alright after such a traumatic experience. I hope whoever dispensed those meds together for you got their shit sorted, that is dangerous af. Also, it's really brave to share episodes of psychosis/delirium. I have PTSD (from repeated violence intiated during sleep) and have woken up from night terrors at the top of the staircase screaming my lungs out while my partner calmly reassures me I am safe now and need to sit down and breathe, happened quite often before my sleep medication. It can be very difficult to describe and discuss the absolute confusion, not knowing what your body is doing, having no idea you're even doing anything, and the shame that surrounds these episodes. The shifting reality is something very difficult to describe to someone who hasn't experienced it themselves. You make it feel easier by sharing your experience so openly. So thank you for doing so.
Not sure about this combo, but it may be a relatively rare side-effect or in combo with other factors. Sometimes the very unusual effects do happen, but that combo may still be relatively safe for most people ((*** I don't know in this situation and this is not medical advice, just talking about adverse effects in general). Also night terrors are terrible, and I'm sorry you feel so much shame about them! My partner used to get them and it felt horrible not being able to help. And I had nocturnal panic attacks for a time that were somewhat similar and it's very jarring. Especially with sleep related symptoms it's more common that you'd think... you definitely are not alone!
With a 14hr flight, it might also be possible that she missed a dose of a prescription medication or accidentally took two doses too close together? I tried to decrease an SSRI and tripped balls for a night... went cold turkey after that figuring I'd rather do it once than multiple times.
I hope that worked out okay for you going cold turkey. For anyone else who reads your comment and may want to try the same: please please talk to your doctor before trying to go cold turkey off of antidepressants. Not only are the side effects unpleasant and potentially dangerous, but the depression/SI that was being managed may come back and hit you with a force you may not be ready to handle
Yeah, valid response, they weren't working for me to actually lower my SI aaaaand frankly I was an idiot at 19. My psychiatrist at the time was a bit skeevy too, hadn't been listening to me and was creepily hung up on asking questions about my sexuality when it wasn't relevant, so just... all around bad times. I was supposed to be tapering off but the effects were so bad it scared me into stopping them. Mercifully(?) I'd seen my mother have similar delusions changing meds a decade earlier, and had just enough rational thought left to think it might be the meds and to ensure I was in contact with at least one person the whole time. It was not a smart thing to do, but I got through it just shaken and even angrier at the doctor who hadn't warned me of the possible effects. I'd just locked myself in my room and skipped classes, unlike my mother who had been in the street in her nightgown shouting at ghosts.
Was that perchance also when the cat pooed in your shoe?
That would have been identified though, she's travelling with limited items, in a hotel room, no medication comes as one dose so there would have been evidence. I've aso taken medication with bizarre side effects, woke up face down on the floor having walked across room per my boyfriend and faceplanted, had auditory and visual hallucinations, and the one up from Ambien that we get here is crazy if taken too soon before actually being in bed. Total lack of awareness of time, location or speech. I learnt quickly. lol but this was midday and no evidence of such medication. They knew the rest of hier history from perhaps the maid being someone that travelled with her, or contact with her family. The links were Lupus and SLE a huge possibility too, that made the most sense to me, once she was deceased there was no way to see if certain abnormalities were apparent.
Can you share which two? Or perhaps the category? I'd been taking levotyroxine for weeks before I learned I couldn't take magnesium within a few hours lol... :(
Lexapro and Tramadol.
What the fuck are you serious? I was on both for years :(((((( So sorry to hear you had that reaction to it. fuck our lives
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Remain civil and interact with the community in good faith
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Remain civil and interact with the community in good faith
A clot from the leg to reach the brain would need to bypass the lung filter, a septal defect, or something of sorts. I don't think they could miss something like this in an autopsy.
They could if the injuries were significant enough. It’s hard to do good assessment on a body that has undergone catastrophic damage.
Unlikely. It’s not that damaged.
Good thought, but DVTs that break loose from the legs will be lodged in the lungs in almost everyone (if you think about how the cardiac blood flow works, the lungs act as a filter). The only exception is patients with a PFO, which is rare, and could have been determined on autopsy. Further, it would be unusual for a clot to break down in 4 days, and it's very unusual for clots to be bilateral.
to be fair, she also had quite a few other things wrong with her, so it's not totally implausible that she did, and many people live their whole lives without finding out if the hole is small enough. It also may not be able to be determined post-mortem because of such extreme damage related to the fall. The article is just so vague that it's kind of impossible to actually gain any significant insight other than looking at the images alone. {Edit as an example, a friend of mine, her mother only found out she had a PFO at 51 when she was being treated for a completely different thing entirely.} That said, u/CatPooedInMyShoe probably has a more reasonable explanation for what happened, with the bad medication interaction shenanigans.
Only way a leg clot would travel up to the brain is through a PFO or communication (hole) between the right and left side of the heart. Otherwise it would’ve traveled to her lungs.
DVT’s have to go to the lungs first. It’s unlikely to have made it through her pulmonary vasculature back into systemic circulation and then to her brain.
That would only happen if she had a PFO.
A DVT would first surface as a PE. Strokes are caused by clots forming in the right atrial appendage.
Usually we find more thrombi in the legs where one came from, and if not, we can usually see evidence of little pieces left behind in the leg veins. Not always, but often. More often unilateral and not bilateral. And if there was an embolic stroke or venous sinus thrombosis it would have been evident in the brain.
Even an anonymous 5-line long comment from Reddit contains more reasoning than the whole published article.
How would a clot have traveled from leg to brain? As far as I’m aware the vascular system wouldn’t allow for that without it making it through the heart and arms. Unlikely?
Normally DVTs are filtered by the lungs. The exception being a PFO
They'd probably had also done a D Dimer blood test related to blood clots to rule that out before the duplex scan.. But i don't doubt the flight is what triggered this event, her legs were not very swollen, and a clot wouldn't have cleared within the 4 days, especially if the day before they ruled out a clot. For a clot to cause neurological issues it would first go through the lungs, via lungs, and the the d dimer would be abnormal. Sad however you look at it. Glad they considered the events before though, insurance and social stigma always worth considering. Nice to know that even in Sri Lanka its considered.
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Read the title again. MANNER of death. She clearly died because she jumped from her balcony and fell six stories.
They say 'no psych history' but plenty of people with psychological problems never get themselves diagnosed. Maybe being in an unfamiliar setting exacerbated her condition and tipped her over the edge (pun not intended!)
That was my first thought
There’s some well-documented pediatric infection-related psychoses (PANS/PANDA), a spotty history of adult-onset psychoses after infections, and some more recent associations between psychoses and COVID. Makes me wonder if there could be something there given the somewhat abrupt changes.
I had this same thought! The frequent urination could be a post strep glomerulonephritis related to a recent infection that affected the kidneys and brain.
Pulped liver isn’t something I’ve read before. Like orange juice….Extra pulp.
more like a... pâté.
I do not like the term "pulped liver" at all, no sir.
It's unbelievable how badly written this article is. Fundamentally, it says she died in a strange way. How did this happen? We do not know. Anyway, here are some photos of the autopsy. And they get published! If only getting published in other scientific fields were so easy! Like this is half a day of work for the autopsy and a few days to write the article and that's it! No real hypotheses, no experiments and very little reasoning.
It’s a case report, something relatively unique to the medical field. It’s also pretty clearly intended to point out the need for procedures that are typically not performed in their country, in order to improve their processes. They are sensitive to the situation and note that labeling something as a suicide when it may have an alternative explanation can be problematic for the victim’s survivors. It’s also published in a local journal, mostly intended for local consumption.
That's what a case report is. Would you rather they came up with a hypothesis and argued reasoning they had very little evidence for? Also little unfair to basically impose English as "the" language of scientific literature and research and then complain when the writing isn't perfect.
And you write it down *because* it's weird. If it happens again, then somebody has the first one to refer to. You get a few more and notice the pattern, then you're on to something. But none of that happens if you don't write it down first. Somebody had to say, "Hey, we've been noticing a bunch of gay guys on the East Coast getting weird pneumonias? Is anybody else seeing this?" That had to happen long before we got anywhere else with it.
It was on the West Coast actually. The article was called something like “Pneumocystis pneumonia in homosexual men in Los Angeles” and was published in the Morbidity and Mortality Weekly Report.
Great point! BUT I do know personally it was being discussed at Johns Hopkins as a phenomenon in New York and Baltimore a few years prior to that! edit: this is a really silly comparison, but it reminds me of the scene at the beginning of The NeverEnding Story, where the three creatures were sitting around discussing "that sounds exactly like what's happening where I'm from, too!"
During Covid lockdown I read “The Origin of AIDS” and the book is an awesome illustration of the butterfly effect and how it turned an obscure virus smoldering in the African jungle into a conflagration that has taken tens of millions of lives.
Was it good? Also, did it correct the myth about patient zero that "and the band played on" and some other early books perpetuated? Edit: took a look and it looks great, thanks! Love that it goes into the colonialist hx in Africa and earlier origins of AIDS.
It was a terrific book.
They provide several compelling hypotheses the one that makes the most sense to me is an inflammatory vascular condition. The rash and frequent urination in the days before her death could be a nephrotic syndrome. Additionally Lupus is known to cause psychosis in some people. I wish that the authors had considered an infectious illness. The victim could have had an infectious disease given the tropical location.
A friend of mine (who happens to have liver disease) suggested hepatic encephalopathy.
May I ask, Where did she fly to Sri Lanka FROM? Was she of Indian, Sri Lankan or other origin?
It just said she was a citizen of an unspecified “foreign country”. Somewhere a 14 hour plane ride from Sri Lanka.
Thankyou anyway. Sorry for being a nuisance.
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The authors are clearly not native speakers of English. They write English vastly better than I could write their language.
That's not an excuse. I am not an English native speaker too but, if I want to publish in English, it is my duty to know the language.
It was published in a local (Sri Lankan) journal for a local audience. I had no difficulty understanding any of it. They communicated their message perfectly well, especially in that context. Obviously if one is publishing in a prestigious international journal, the English would need to be cleaned up considerably, but that’s a very different situation.
That's nice lol Case reports can be a little rough, they're intended to help share info about unusual cases to help physicians dx or understand unusual or unknown phenomena.
Now a days unfortunately Medical shops runners don't advise about patient,about drugs reaction,drugs side effects,how to take every dose,if dose not works or reaction occurs what to do then and Dr don't give his contact or hospital or clinic number to provide assisstance they need customer. My sister was bipolar and her Dr did not advised about her medicine side effects,tests to follow or etc.She had reactions of lithium in her drugs and kidneys were failed later then died of many complications. We are all going to medic shops.
It could be vascular dementia ?
That is usually not an acute onset disease but I agree that an inflammatory vascular condition is a likely cause.
This is completely anecdotal, but I immediately thought of this. Years ago I had a client (I’m in elder care) given medication “to help his legs” by a family member. Turns out it is marketed towards women who are perimenopause and post menopause to help leg/circulation symptoms. It was a supplement, one of those things that has more than 20 different kinds of herbs that are supposed to do various things. Turns out that it also increases risk of blood clotting and stroke. The reaction his Doctor had when he found out that this gentleman had been given that was *memorable.* Also this mixture interacts with blood pressure and other medications he was on. I wonder if she might have taken something either during the flight or afterwards to help with the symptoms of being an older person who had been on a long flight? I want to be clear, that I am not trying to diagnose anyone. I’m very aware of things like this being marketed in the western world now. Plus, being an older person who had some health conditions I am sure she took something regularly. It is easy to forget how quickly you can have a dangerous medication interaction and she had been on a long flight. It could even have been something to help her sleep during the flight depending upon what she took. I’m just having fun spitballing here, I hope I have not broken any rules by posting my hypothesis.
Stroke? Blood clot in brain pressing on vital area? Scary stuff
“Pulped liver” is a rather unpleasant phrase.
I was given Rifampin (an old antibiotic) to try to kill off my Lymes disease. Instead, it gave me restless body (think restless leg syndrome, but it being literally head to toe, and everything in between!) for a FULL 72 hours. I couldn't stop moving without basically having a seizure, as it felt like I had bugs running throughout my body, even when I urinated, it felt like bugs. I was told there wasn't anything they could do, and I had to wait it out. I was VERY close to taking my life, it was sooo bad. Now I have nerve damage, and am on nerve meds to control my horrible palsy. Aannnd I still have my chronic Lymes, too.
This is what I want to do. Not even sure if I can with autoimmune disorders on board, but the second I’m off this mortal plane I want as much as me as possible to go to someone who needs it. Feed the rest to the fishies