title: Causes of unexpected death in patients with multiple sclerosis: a forensic study of 50 cases.
abstract: To determine the cause of death (as a result of neurologic or nonneurologic complications or accidents) in patients with multiple sclerosis (MS), we reviewed the autopsies of 50 subjects with MS from the Office of the Chief Medical Examiner of Maryland (OCME) between 1982 and 2004. The series included 32 females and 18 males (mean age, 45.8 years; range, 25-69 years) and the causes of death were classified into 3 categories: (A) neurologic complication directly related to MS; (B) nonneurologic complications or other medical causes; and (C) accidents, etc. Of the 50 cases, in 43 there was a history of MS, but in 7 subjects there was not, and the diagnosis was established by neuropathologic examination. In Group A, 21 (42%) cases, deaths were directly related to a neurologic complication; in Group B, 14 (28%) cases were related to the following nonneurologic and medical causes: ASCVD 9 (18%), metabolic disorder 1 (2%), pulmonary embolism 3 (6%), and bronchopneumonia 1 (2%); and in Group C, 15 (30%) cases, deaths were due to trauma, 9 (18%); intoxication, 5 (10%); and thermal injury, 1 (2%). Thus, among the 50 subjects, in 26, deaths occurred naturally; and in 24, from accidents, homicides, suicides, or undetermined causes. Pathologically, the majority of cases showed either chronic inactive (66.7%) or chronic active (15.6%) demyelinating lesions, mainly in the cerebral hemispheres. In some cases, it appears that demyelinating lesions, involving brain regions that regulate cardiorespiratory activity, could be considered as the immediate cause of death, but a large proportion appears to be due to other causes such as accidents and trauma. Thus, it seems likely that taking specific precautions could prevent some deaths in MS.
authors.affiliation: Division of Neuropathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. mriudav1@jhmi.edu
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Riudavets
authors.forename: Carlos
authors.initials: C
authors.lastname: Colegial
authors.forename: Ana
authors.initials: A
authors.lastname: Rubio
authors.forename: David
authors.initials: D
authors.lastname: Fowler
authors.forename: Carlos
authors.initials: C
authors.lastname: Pardo
authors.forename: Juan C
authors.initials: JC
authors.lastname: Troncoso
mesh_terms: D000328:Adult; D000368:Aged; D001344:Autopsy; D002423:Cause of Death; D005260:Female; D005554:Forensic Medicine; D049429:Forensic Pathology; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000401:mortality* / Q000473:pathology