title: Non-traumatic subdural hematoma secondary to septic brain embolism: A rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis.
abstract: Acute subdural hematomas are mostly due to blunt traumatization of the head. In rare instances, subdural bleeding occurs without evidence of a previous trauma following spontaneous hemorrhage, e.g. from a ruptured aneurysm or an intracerebral hematoma perforating the brain surface and the arachnoid. The paper presents the morphological, microbiological and toxicological findings in a 38-year-old drug addict who was found by his partner in a dazed state. When brought to a hospital, he underwent trepanation to empty a right-sided subdural hematoma, but he died already 4h after admission. Autopsy revealed previously undiagnosed infective endocarditis of the aortic valve as well as multiple infarctions of brain, spleen and kidneys obviously caused by septic emboli. The subdural hematoma originated from a subcortical brain hemorrhage which had perforated into the subdural space. Microbiological investigation of the polypous vegetations adhering to the aortic valve revealed colonization by Streptococcus mitis and Klebsiella oxytoca. According to the toxicological analysis, no psychotropic substances had contributed to the lethal outcome. The case reported underlines that all deaths of drug addicts should be subjected to complete forensic autopsy, as apart from intoxications also natural and traumatic causes of death have to be taken into consideration.
authors: Institute of Forensic Medicine, Freiburg University Medical Centre, Albertstrasse 9, 79104 Freiburg, Germany. Electronic address: dorothee.geisenberger@uniklinik-freiburg.de.
authors: D
authors: D
authors: Geisenberger
authors: Institute of Forensic Medicine, Freiburg University Medical Centre, Albertstrasse 9, 79104 Freiburg, Germany.
authors: L M
authors: LM
authors: Huppertz
authors: Institute of Med. Microbiology and Hygiene, Freiburg University Medical Centre, Hermann-Herder-Strasse 11, 79104 Freiburg, Germany.
authors: M
authors: M
authors: Büchsel
authors: Institute of Forensic Medicine, Freiburg University Medical Centre, Albertstrasse 9, 79104 Freiburg, Germany.
authors: L
authors: L
authors: Kramer
authors: Institute of Forensic Medicine, Freiburg University Medical Centre, Albertstrasse 9, 79104 Freiburg, Germany.
authors: S
authors: S
authors: Pollak
authors: Institute of Forensic Medicine, Freiburg University Medical Centre, Albertstrasse 9, 79104 Freiburg, Germany.
authors: M
authors: M
authors: Große Perdekamp
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000382:microbiology / Q000473:pathology; D020520:Brain Infarction / Q000209:etiology / Q000473:pathology; D055030:Drug Users; D004697:Endocarditis, Bacterial / Q000150:complications / Q000473:pathology*; D017809:Fatal Outcome; D020199:Hematoma, Subdural, Acute / Q000209:etiology / Q000473:pathology*; D006801:Humans; D007238:Infarction / Q000209:etiology / Q000473:pathology; D020766:Intracranial Embolism / Q000150:complications / Q000382:microbiology* / Q000473:pathology*; D020300:Intracranial Hemorrhages / Q000150:complications / Q000473:pathology; D007668:Kidney / Q000098:blood supply / Q000473:pathology; D007710:Klebsiella Infections / Q000150:complications; D041121:Klebsiella oxytoca / Q000302:isolation & purification; D008297:Male; D013159:Splenic Infarction / Q000209:etiology / Q000473:pathology; D013290:Streptococcal Infections / Q000150:complications; D034361:Streptococcus mitis / Q000302:isolation & purification
keywords: Drug addiction; Infective endocarditis; Septic embolization; Streptococcus mitis; Subdural hematoma