Neurogenic pulmonary edema in unexpected, unexplained death of epileptic patients

Eight cases of unexpected, unexplained death in young ambulatory epileptics were examined postmortem with special attention to the heart and lungs. Lung weights uniformly exceeded the expected value, with gross evidence of hemorrhagic pulmonary edema. Microscopic examination revealed moderate to severe pulmonary edema with protein-rich fluid as well as alveolar hemorrhage. There was no evidence of recent or old myocardial disease. Although death due to a seizure is usually thought to be almost instantaneous, the neurogenic pulmonary edema exemplified by these cases takes time to develop and may be remediable. The high frequency of absent or non-therapeutic anticonvulsant levels at the time of death in these patients may play a role in a possible centrally mediated adrenergic cause of neurogenic pulmonary edema and ventricular arrhythmia.