NDIANG’UI

 UNEXPECTED DEATHS

 24th September 2009

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SUDDEN UNEXPECTED DEATHS
A wide range of deaths are encountered in the field of
forensic pathology, most of them sudden and
unexpected.
*Most of the times its due to natural causes
They have medical legal implications
Laws affecting medical legal autopsy postulate for
autopsy to performed on all cases of sudden and
unexpected deaths
death certificate should not be issued until case is
reported to police

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Cont…
WHO – Sudden death is that death that occurs within
24 hrs from the onset of the symptoms.
Some authors have considered to be 6 – 12 hours from the
onset
Usually the problem is distinguishing between
natural and unnatural causes and sometimes between
trauma and disease

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Cont…
E.g
homicides involving arsenic or cyanide may mimic
natural death
A person known to have a disease and suffers injury,
questions arise;
 Was the traumatic event solely responsible for the death?
 Was the cause of death solely due to disease and would have occurred irrespective
of the injury?
 Did the injury contribute to death to a lesser or greater degree?

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Cont…
What do you make of an assaulted victim who dies
later after stroke or the negligent minor accident that
has a fatal pulmonary embolism!!

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Causes of sudden death
The immediate cause of death is almost always to be
found in the CVS (heart , great vessels and the
peripheral vasculature)

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Cont….
CVS
Coronary artery
Coronary atherosclerosis
Coronary artery embolism
Dissecting aneurysm
Heart
MI
Hypertensive heart disease
Valvular heart disease
myocarditis

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Cont…
Great vessels
Dissecting aneurysms
Respiratory
Pulmonary embolism
Haemoptysis
Spontaneous pneumothorax

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Cont…
CNS
Subarachnoid haemorrhage
Cerebral haemorrhage
Epilepsy
Cerebral embolism
GIT
Haemorrhage (ulcers, varices, tumours)
Acute haemorrhagic pancreatitis

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Cont…
Mesenteric thrombo embolism
Alcoholic liver disease
Endocrine
Thyroid
Adrenal
Pancrease
Parathyroid
GUT

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Autopsy in sudden death
Autopsy should be systematic
History – the amount of history available during
autopsy is variable. Effort should be made to get
history from relatives, physician, police
Age, gender, lifestyle
Circumstances of death
Medical hx
Drugs-prescription or otherwise

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Cont…
Actual autopsy
A full autopsy that is systematic
External exam
Internal examination
CVS
Respiratory
CNS
GIT

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Cont…
When an autopsy fails to reveal structural
abnormalities that establish the cause of death, the
following are indicated;
Toxicology
Histology
Microbiology
Biochemistry

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Autopsy Consideartions
The outcome in Sudden Death
of autopsy may indicate;
Presence of structural abnormalities that establish
beyond doubt the cause of death because the disease
process is incompatible with life
The autopsy changes are adequate to account for the
death
The cause of the death is established with aid of
positive or negative anatomical findings, histological,
biochemical and toxicological investigations

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Neither the anatomical or lab investigations can explain
the cause of death

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What is the value of microscopic examination and
toxicology investigations in sudden death ?

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SUDDEN INFANT DEATH
SYNDROME (SIDS)

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Definition - SIDS
Sudden Infant Death Syndrome
(crib death) - the sudden death of an
infant, usually under 1 year of age, which remains
unexplained after a complete postmortem
investigation, including an autopsy, examination
of the death scene and review of the case history

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SIDS Statistics
Classified as a disorder
Leading cause of death in infants 1 month to 1
year old
95% occur between 1 & 6 months of age - peak
period between 2 & 4 months

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SIDS -
Sudden & silent in an apparently
healthy infant
Unpredictable & unpreventable
Quick death with no signs of
suffering - usually during sleep

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General Characteristics of SIDS
Usually occurs in colder months
Mothers younger than 20 years old
Babies of mothers who smoke during pregnancy
or are exposed to second hand smoke
60% male Vs 40% female
Premature or low birth weight
Upper respiratory infections, 60% in prior weeks
Occurs quickly and quietly during a period of
presumed sleep

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Findings
Normal state of hydration & nutrition
Small amount of frothy fluid in or about mouth &
nose
Vomitus present
Postmortem lividity &/or rigors
Livormortis
Disfiguration/Unusual position - dependant
blood pooling/pressure marks

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Cont…
Pulmonary congestion & edema
Intrathoracic petechiae 90% of time
Stomach contents in trachea
Microscopic inflammation in trachea

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Typical SIDS Infant Scenario
Almost always occurs during sleep or
appearance of sleep
Usually healthy prior to death
May have had a cold or recent physical stress
May have been place down for nap, found not
breathing or appearing dead
Parents not hearing signs of struggle

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Cont…
Observe for
Location of infant
Presence of objects in area infant found
Unusual conditions
High room temperature
Odors

Anything out of ordinary

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