title: Subarachnoid hemorrhage and carbon monoxide exposure: accidental association or fatal link?
abstract: This case study reports a fatal subarachnoid hemorrhage (SAH) with concomitant accidental carbon monoxide (CO) exposure in 32-year-old man. Autopsy results indicated an antemortem aspiration of smoke, and a massive SAH was identified as the cause of death. Intriguingly, the carboxyhemoglobin level was 30%, suggesting that CO could have played a specific role. Intracranial hemorrhages following CO exposure in brain areas and tissues such as the basal ganglia, globus pallidus, or white matter are rare, but well characterized, whereas SAH related to CO exposure has not been previously described. In this case report, the possible role of CO, either as a primary cause or as a facilitating factor, in the pathogenesis of SAH is discussed. In particular, we propose the hypothesis that the excessive vasodilating effects produced by CO on the cerebral endothelium results in consequential loss of microvascular integrity.
authors.affiliation: Institute of Legal Medicine, Catholic University, Medical School, Largo F. Vito 1, 00168 Rome, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: De-Giorgio
authors.affiliation: Institute of Legal Medicine, Catholic University, Medical School, Largo F. Vito 1, 00168 Rome, Italy.
authors.forename: Vincenzo M
authors.initials: VM
authors.lastname: Grassi
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, La Sapienza, University of Rome, Corso della Repubblica 79, 04100 Latina, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Miscusi
authors.affiliation: Institute of Pharmacology, Catholic University, Medical School, Largo F. Vito 1, 00168 Rome, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Mancuso
authors.affiliation: Department of Public Health, Forensic Medicine Section, Cagliari University, Km 4.500 SS. 554 Bivio per Sestu, 09042 Monserrato, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: d'Aloja
authors.affiliation: Institute of Legal Medicine, Catholic University, Medical School, Largo F. Vito 1, 00168 Rome, Italy.
authors.forename: Vincenzo L
authors.initials: VL
authors.lastname: Pascali
mesh_terms: D000328:Adult; D002248:Carbon Monoxide / Q000633:toxicity*; D002263:Carboxyhemoglobin / Q000032:analysis; D004781:Environmental Exposure / Q000009:adverse effects*; D049429:Forensic Pathology; D006801:Humans; D007830:Larynx / Q000473:pathology; D008168:Lung / Q000473:pathology; D008297:Male; D015208:Smoke Inhalation Injury / Q000473:pathology; D053260:Soot; D013345:Subarachnoid Hemorrhage / Q000473:pathology*; D014132:Trachea / Q000473:pathology
chemical_list: D053260:Soot; D002248:Carbon Monoxide; D002263:Carboxyhemoglobin
keywords: carbon monoxide; carboxyhemoglobin; forensic autopsy; forensic pathology; forensic science; subarachnoid hemorrhage