[Death or uncertain cause]

The unclear case of death usually occurs suddenly and unexpectedly, but can mostly be attributed to a underlying disease which was unknown during the life-time of the patient. A reduction of mortality might be achieved by improved preventive measures and early treatment. During the last years, the sleeping apnea syndrome as an example turned out to be a considerable risk factor for cardiovascular diseases and accidents. Nevertheless, very many patients exist with an unrecognized sleeping apnea syndrome and are in urgent need of therapy. At first, unclear cases of death in the area of internal medicine can mostly be solved by an autopsy. Autopsy results are demonstrating that only one of three pulmonary embolism has been recognized clinically. The correct diagnosis for an unexpected death in the area of internal medicine could be almost ever found by a more careful differential diagnosis; only a few cases of death remain unclear after optimal diagnostics. At first, one has to think of a pulmonary embolism, cardiac arrhythmias or myocardial ischemia when a sudden death has occurred. Additionally, a pneumothorax, an alimentary bolus or an asthma attack may cause death unexpectedly. Metabolic dysfunctions, poisoning or a ruptured aortic aneurysm are often not recognized as the cause of death if it is not especially looked for.