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CNS

CNS. The most common causes of death are: Epilepsy Subarachnoid hemorrhage Intracerebral hemorrhage Meningitis tumours. Epilepsy.

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CNS

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  1. CNS The most common causes of death are: • Epilepsy • Subarachnoid hemorrhage • Intracerebral hemorrhage • Meningitis • tumours

  2. Epilepsy • Sudden Unexpected Death in Epilepsy is a term used when a person with epilepsy suddenly dies, , in whom a postmortem examination fails to uncover a gross anatomical, toxicological or environmental cause of death. • Death in an epileptic patient could be by asphyxia during a fit in bed when the face is pressed into the pillow. • Also it may cause due to traumatic deaths because of fits occurring when pt in some vulnerable position. • Antiepileptic drug overdose

  3. Autopsy • Should always include a search for bites on the tip and distal tongue which suggest fit. • Examination of Brain is essential : to search for any cause of post-traumatic epilepsy • On Heart Ex : patchy myocardial fibrosis caused by episodic hypoxia from apnea from fits .

  4. Subarachnoid hemorrhage • SAH is a very serious neurological emergeny and it is the fourth most common intracranial cause of death. • This may occur spontaneously, or may result from head injury. • 85% of spontaneous SAH is caused by rupture of “saccular” berry aneurysms. • Aneurysms are usually found at bifurcation of the cerebral arteries,particulary in the region of circle of willis.

  5. SAH typically presentswith a sudden sever “thunderclap” headache (often occipital) which lasts for hours or even days,sometimes accompanied by vomiting • There may be loss of consciousness at the onset. • Any rise in the blood pressure will cause rupture of the apex of the aneurysm also occurs after: Emotions, exercise, alcohol, sexual intercourse, and direct trauma to the neck… • Most cases of death are due to vasospasm following the rupture .

  6. Autopsy • Point of bleeding in the circle of Willis more dense at the base of the brain especially basal cisterns. • Bright red in fresh blood , brown in older bleeding.

  7. Intracranial hemorrhage • ICH is bleeding directly into the brain parenchyma itself • The most common cause is hypertentionby damaging the small intracerebralarterioles,or acute rise in BP which cause rupture of penetrating arteries • Other causes include trauma,use of anticoagulants,use of drugs like cocaine or amphetamines,vascularmalformation,or hemorrhage in an underlying brain tumor.

  8. autopsy • Deep hemorrhage anywhere within the hemisphere. • Rupture inside the ventricular system. • Sever contrecoup lesions : large hematomas in one or both hemisphere.

  9. Meningitis • Mortality rate 5% in children,25% in neonates • The severity depends on the causative organism.Eg: untreated TB meningitis is fatal in a few weeks. • The patient may have chills, high fever, dizziness, nausea, vomiting,headaches or weakness. Petechiae appear on the body in 75% of cases. • In 10% of the cases there is a rapidly progressive course with toxemia, shock, and collapse. The individual may die in less than 10 hrs from the onset of symptoms. • Sometimes, a person who is walking around will collapse and die. At autopsy pt will be found to have meningococcemia.

  10. Meningitis • Autopsy a diffuse (widespread) inflammation of the pia-arachnoid area. Neutrophil,leucocytes tend to have migrated to the cerebrospinal fluid and the base of the brain + cranial nerves + spinal cord, may be surrounded with pus as may the meningeal vessels. • There may be cyanosis,petichiae,and purpura of the skin,acute bilateral hemorrhagic adrenal necrosis

  11. Tumors • High mortality rate associated with grade 4 glioma(glioblastoma multiform) • 20% of glioma survive for 1 year.

  12. Respiratory system • Sudden death due to disease of RS comprises only a small proportion of all sudden deaths. • The common causes of sudden death include: • Pulmonary thromboembolisim. • Asthma • Penumonia • Hemoptysis

  13. Pulmonary embolism • It is a Major cause of sudden death in RS. • It is a common mode of death in patients with cancer and stroke and remains the most common cause of death in pregnancy • 75% of PE arise from the propagation of lower limb DVT • Predisposing factors include immobility,pregnancy,trauma,surgery… • As result a small emboli break off and impact in the peripheral branches of pulmonary arteries infarction. • Massive emboli occlude major pulmonary vessels.

  14. Bronchial asthma • Death occurs suddenly, with no findings at autopsy except in chronic asthma state. • some cases are apparent due to status asthmaticus, others due to drug overdose • Drugs: theophylline and sympathomimetic agents  ventricular fibrillation.

  15. Hemoptysis • Rare. • pulmonary tuberculosis • bronchial tumors rarely cause a fatal hemoptysis, unless major vessel is eroded. The bleeding causes death by sudden filling of the larynx with blood,causing asphxia

  16. Done by : SAEED KHATEEB D3 Thank You

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