Sudden and unexpected death due to hemorrhage from occult central nervous system lesions. A pediatric autopsy study

A retrospective review of the Department of Histopathology files at the Adelaide Children's Hospital was conducted to examine all cases where sudden death (defined as death occurring within 24 h of sudden collapse and unconsciousness in a previously apparently well child) was attributable to hemorrhage from an occult central nervous system lesion. Ten cases were found with significant hemorrhage and associated cerebral edema. The diagnoses were cerebral arteriovenous malformation (1), probable cerebellar vascular malformation (4), berry aneurysm of middle cerebral artery (1), cerebellar medulloblastoma (1), optic chiasm astrocytoma (1), pineal gland teratoma (1), and fourth ventricle ependymoma (1). These cases demonstrate the wide range and variable location of intracranial lesions capable of causing sudden death in children. Careful examination of the brain in all cases of sudden pediatric death is essential so that intracranial lesions causing unexpected death will be adequately characterized.