Likely Cause of Death: Intracranial Hemorrhage from Fall-Related Traumatic Brain Injury
The most likely cause of death in this patient is an acute intracranial hemorrhage (subdural or epidural hematoma) resulting from the fall, which went undiagnosed due to the absence of neuroimaging. The temporal sequence—fall with head trauma, immediate headache, and death within 24 hours—is classic for a rapidly expanding intracranial bleed that was missed without CT scanning.
Clinical Reasoning
Primary Mechanism of Death
Traumatic intracranial hemorrhage is the most probable cause given the acute presentation of headache immediately following head trauma and rapid deterioration to death within one day 1.
The absence of neuroimaging represents a critical missed opportunity to diagnose a potentially treatable neurosurgical emergency, as head CT is the standard of care for evaluating head trauma with neurological symptoms 1.
Patients with ovarian cancer awaiting surgery may have thrombocytopenia from disease or malnutrition, increasing bleeding risk, though this is not the primary mechanism 1.
Why Ovarian Cancer Itself Is Less Likely
While ovarian cancer remains the primary cause of death within 15 years of diagnosis, mortality from external causes such as falls increases with time since diagnosis 1.
Brain metastases from ovarian cancer are exceedingly rare, occurring in less than 2% of cases, typically present more than one year after diagnosis in advanced-stage disease, and would not cause death within 24 hours of symptom onset 2.
The patient was awaiting initial surgery, suggesting newly diagnosed disease without time for metastatic spread to develop 2.
Ovarian cancer deaths typically occur from peritoneal carcinomatosis, bowel obstruction, or treatment complications—not acute neurological events 3.
Critical Pitfall in This Case
The failure to obtain head CT imaging after a fall with headache in a hospitalized patient represents a significant deviation from standard care. Any patient experiencing head trauma with subsequent headache requires immediate neuroimaging to exclude intracranial hemorrhage, regardless of their underlying cancer diagnosis 1.
Risk Factors That May Have Contributed
Older age increases both fall risk and surgical mortality in ovarian cancer patients, with perioperative mortality rising from 17% in patients under 50 to 32% in those over 80 years 1.
Patients with ovarian cancer have documented increased mortality from falls, emphasizing the importance of fall prevention strategies in this population 1.
Malnutrition, hypoalbuminemia (common in advanced ovarian cancer), and potential coagulopathy could have exacerbated bleeding from the head injury 1.
What Should Have Been Done
Immediate head CT without contrast should have been obtained when the patient developed headache after the fall 1.
Neurosurgical consultation would have been indicated if imaging revealed an expanding hematoma requiring evacuation 1.
Serial neurological assessments every 1-2 hours should have been performed even without imaging, watching for declining mental status, focal deficits, or signs of increased intracranial pressure 1.