Abstract 17905: Sudden Neurological Death: A Substantial Contributor to Causes of WHO Sudden Cardiac Deaths
Background: Sudden deaths, particularly deaths that meet the World Health Organization (WHO) criteria for sudden cardiac death (SCD), are often ascribed to a cardiac cause, but low prevailing autopsy rates raise the possibility that non-cardiac, including neurological causes of sudden death could be missed.
Methods: During the first 16 months of the Comprehensive UCSF SCD Study (2/2011-5/2012), systematic autopsies were performed on 187 of 201 (93%) incident WHO SCDs that were captured through active surveillance of all deaths reported to the San Francisco Medical Examiner’s Office. Evaluation for all cases included full autopsy, toxicology, histology, and detailed examination of the heart and cranial vault. A multidisciplinary committee (cardiology, electrophysiology, pathology, and neurology) reviewed prehospital reports, medical records, and autopsy results to adjudicate a final cause of death by consensus.
Results: Of 187 consecutive autopsied WHO SCDs, 14 (7.5%) were due to neurological causes (mean age 60 [SD 19], range 27-87; 79% female) and accounted for 20% (14 of 70) of non-cardiac causes of sudden death. Neurological etiologies included 6 intracranial hemorrhages, 6 cases of Sudden Unexpected Death in Epilepsy (SUDEP), one aneurysmal subarachnoid hemorrhage, and one ischemic stroke. SUDEP was definite in one case, probable in 3 others, and possible in 2 others. Two had a history of juvenile myoclonic epilepsy. Most deaths were unwitnessed (12; 86%) and presented with asystole (13; 93%). A history of seizures was significantly associated with sudden neurological death (OR 13 [95% CI 3.9-43], p<0.001) but a history of stroke or TIA was not.
Conclusions: Sudden neurological death accounts for a substantial proportion of WHO SCDs. Low autopsy rates may contribute to misclassification of sudden neurological death as due to a cardiac cause, thus preventing its prior recognition and underestimating its incidence.
- © 2013 by American Heart Association, Inc.