A review of subarachnoid haemorrhage as a cause of death in forensic autopsies conducted in Edinburgh

Abstract

INTRODUCTION: Sudden death due to subarachnoid haemorrhage (SAH) has been frequently encountered in routine forensic autopsies all over the world. OBJECTIVE: To review autopsy reports on cases diagnosed as death due to SAH. Demographic data, medical aspects, events leading to death and underlying pathology were analysed and compared with previous autopsy studies. DESIGN, SETTING AND METHODS: Materials were gathered from a post-mortem report database maintained at the Section of Forensic Medicine, Division of Pathology, University of Edinburgh between 2000-2005. Events leading to death and details relating to medical history were gathered from the sudden death reports provided by the Police. RESULTS: 67 (0.8%J cases were diagnosed as deaths due to SAH out of 8,264 autopsies. Male to female ratio was 3:3.7. Majority of the victims were in their fifth or sixth decade. 51 (76%) cases had a rupture of a cerebral aneurysm while 6(9%) were related to trauma. 21(40%) had a past medical history of hypertension, ischaemic heart disease or a cerebro-vascular accident. Only two cases had a history of SAH with aneurysma! clipping. 19 cases recorded presence of additional unruptured aneurysm (2mm -10mm) at the autopsy. The majority of ruptured aneurysms were in posterior part of circle of Wiliis. CONCLUSIONS: Medicai and pathological causes of sudden death due to SAH have not changed despite the improvement of the imaging technology or increased availability to access medical information and advice