[The phenomenology and morphology of spontaneous fatal cerebral aneurysmal hemorrhages]

Abstract

Hemorrhages from rupturing aneurysms in the main cerebral arteries are repeatedly the object of forensic dissection. The victims are often relatively young, death is sudden and unexpected, and there is no known history of serious illness. Of a total 62,888 dissections carried out by the Institut für Rechtsmedizin of the Free University of Berlin (1956-1984), the University of Hamburg (1970-1984), and the University of Munich (1964-1984), there were 246 such cases (0.39% of the dissected material); 122 were male and 124 female. To compare possible differences between these cases and clinically conducted autopsies with regard to localization and extent of the aneurysm, age and sex of the deceased, an evaluation of the dissected material of the Department of Neuropathology, University Hospital, Hamburg-Eppendorf (1960-1984) was carried out simultaneously in altogether 160 cases, 66 male and 94 female. The phenomena are discussed. In the morphological findings, particular attention is focused on the occasional difficulty in establishing the source of the hemorrhage, which is of crucial importance when differentiating from traumatically caused hemorrhages. Some specific, particularly problematic causes (e.g., where errors were made in medical treatment), are presented in the form of case histories.