Abstract
Sudden unexpected death due to central nervous system (CNS)-related pathologies though far less common than cardiac causes still account for a substantial proportion of sudden deaths that occur worldwide. This review covers the most common causes of sudden unexpected death due to CNS-related pathologies encountered by forensic pathologists. These include intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage, ischemic stroke, epilepsy, brain tumors, and infectious causes. Related rare causes are not discussed and are beyond the scope of this review. The role of neuroimaging and genetic testing as autopsy ancillary investigations in such sudden deaths is also discussed.
Highlights
BackgroundSudden natural death is one of the intriguing cases seen in forensic pathology
Postmortem molecular autopsy of Sudden unexpected death in epilepsy (SUDEP) cases discovered variants in genes encoding for sodium and potassium ion channel subunits, and 18 genes and four different duplications have been reported to have a possible link to SUDEP [76]
Sudden death due to CNSrelated pathologies is less common when compared to cardiovascular causes
Summary
Sudden natural death is one of the intriguing cases seen in forensic pathology. It is defined as natural unexpected nontraumatic death in apparently healthy individuals occurring instantaneously or in less than 24 hours after the onset of clinical symptoms [1]. Microscopic examination of the brain revealed a vascular malformation in the right thalamus and the cause of death was intraventricular hemorrhage [12] Another case describes a 53-year-old man, a known hypertensive with elevated cholesterol, who was found dead at home by his wife [12]. The autopsy on another two cases revealed anaplastic astrocytoma (WHO grade III), which presented with neurological symptoms before the time of death Another case describes a 67-year-old man who presented to the hospital with a diagnosed brain tumor a month prior to his death [45,48]. Other primary intracranial tumors reported in the literature to cause sudden unexpected death are exceedingly rare. Postmortem molecular autopsy of SUDEP cases discovered variants in genes encoding for sodium and potassium ion channel subunits, and 18 genes and four different duplications have been reported to have a possible link to SUDEP [76]
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