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[The etiology of sudden cardiopulmonary arrest in subarachnoid hemorrhage]
1Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Insights
Sudden death in subarachnoid hemorrhage (SAH) is often sudden cardiopulmonary arrest (CPA). This study found less severe SAH and myocardial contraction band necrosis in sudden death cases.
Area of Science:
- Neurology
- Pathology
- Cardiology
Background:
- Sudden death due to subarachnoid hemorrhage (SAH) is a recognized clinical event.
- The precise mechanisms leading to sudden cardiopulmonary arrest (CPA) in SAH remain incompletely understood.
Purpose of the Study:
- To investigate the etiology of sudden CPA in patients with SAH.
- To compare characteristics of sudden death SAH patients with those of severe SAH (WFNS Grade V).
Main Methods:
- Retrospective analysis of 68 consecutive patients with sudden death and SAH (DOA group).
- Comparison with SAH patients of WFNS Grade V (V group).
- Evaluation of clinical symptoms, CT scans, autopsy findings, and postmortem myocardial histology.
Main Results:
- The DOA group represented 10% of intrinsic sudden death patients and 10% of all SAH patients.
- Pulmonary edema was significantly more frequent in the DOA group (P < 0.01).
- CT findings indicated less severe SAH in the DOA group (S type more frequent, lower CT Score and MAX. CT NO., P < 0.01).
- Myocardial contraction band necrosis was observed in all 6 examined DOA cases.
Conclusions:
- Subarachnoid hemorrhage leading to sudden death may not always be severe.
- Pulmonary edema and myocardial contraction band necrosis are significant findings in SAH-associated sudden death.
- Further research is needed to elucidate the mechanisms of CPA in SAH.
Abstract:
Sudden death due to subarachnoid hemorrhage (SAH) is not uncommon. However, the mechanism remains unclear. In this paper, sixty-eight consecutive patients with sudden death in SAH (DOA group) were studied to clarify the etiology of sudden cardiopulmonary arrest (CPA) in SAH. SAH was confirmed by CT scan and/or by autopsy. These patients accounted for 10% of the total intrinsic DOA patients in that period. Clinical symptoms, CT scan and autopsy findings concerning the DOA group were carefully evaluated and compared to those of patients with SAH of WFNS Grade V (V group). The DOA group accounted for 10% of all SAH patients. Average time interval from the onset of SAH to the recognition of CPA was 21.2 minutes. In 30% of cases, the time interval was within 15 minutes. Pulmonary edema was recognized as being significantly higher in the DOA group than in the V group (P < 0.01). In CT finding, the number of patients who were classified into S type (mainly subarachnoid clot only) was significantly higher in the DOA group than in the V group (P < 0.01). The CT Score and MAX. CT NO. in the DOA group were significantly lower than in the V group (P < 0.01 and P < 0.0001, respectively), suggesting that the intensity of subarachnoid hemorrhage was not severe in the DOA group. Postmortem histological examination of the myocardium was carried out on 6 cases of the DOA group. A contraction band necrosis in the myocardium which did not correspond to the coronary perfusion area was found in all 6 patients.(ABSTRACT TRUNCATED AT 250 WORDS)