Survey of Sudden Death From Aneurysmal Subarachnoid Hemorrhage in Cadavers Referred to Legal Medicine Organization of Tehran, 2001–2005

BACKGROUND AND AIM: Some cases with aneurysmal subarachnoid hemorrhage (SAH) never reach the medical centre alive and they are not included in most studies of SAH. To explain the clinical profile of sudden death from aneurysmal SAH, we examined the epidemiology and clinicopathologic characteristics of patients with aneurysmal SAH who never reached medical attention or died within first 24 hours of the onset of first symptoms. MATERIALS AND METHODS: Using the autopsy records in Legal Medicine Organization of Tehran, we identified all cadavers who were diagnosed with aneurysmal SAH between 2001 and 2005. RESULTS: There were 85 women and 60 men with a mean age of 50 years. Twenty patients (14%) died without reaching medical care and 58 (40%) died within first 24 hours of the onset of first symptoms. The remnant had died after 24 hours to 28 days of hospitalization. In comparing patients with sudden death versus remnant, the main variables were the frequency of posterior circulation aneurysms that was found in 59% compared with 19.4% in those who had died after 24 hours, intraventricular hemorrhage 53.8% versus 19.4%, and pulmonary edema 92.3% versus 34.3% (P = 0.01). CONCLUSION: In our population, the frequency of sudden death from aneurysmal SAH has not changed during the last 5 years. The typical clinical profile of sudden death in SAH includes intraventricular hemorrhage, pulmonary edema, and a ruptured posterior circulation aneurysm. Intracerebral hemorrhage is rarely connected to sudden death from aneurysmal SAH.