[The etiology of sudden cardiopulmonary arrest in subarachnoid hemorrhage].
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)
Department of Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
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Kitahara
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Masuda
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Soma
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000150:complications; D002423:Cause of Death; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D006323:Heart Arrest / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000000981:diagnostic imaging; D013997:Time Factors; D014057:Tomography, X-Ray Computed