Neurogenic pulmonary edema in unexpected, unexplained death of epileptic patients

Abstract

Eight cases of unexpected, unexplained death in young ambulatory epileptics were examined postmortem with special attention to the heart and lungs. Lung weights uniformly exceeded the expected value, with gross evidence of hemorrhagic pulmonary edema. Microscopic examination revealed moderate to severe pulmonary edema with protein-rich fluid as well as alveolar hemorrhage. There was no evidence of recent or old myocardial disease. Although death due to a seizure is usually thought to be almost instantaneous, the neurogenic pulmonary edema exemplified by these cases takes time to develop and may be remediable. The high frequency of absent or non-therapeutic anticonvulsant levels at the time of death in these patients may play a role in a possible centrally mediated adrenergic cause of neurogenic pulmonary edema and ventricular arrhythmia.

Sudden unexpected, unexplained death in epilepsy autopsied patients

“…In Terrence s study, 3 of 8 SUDEP cases were prescribed phenytoin and phenobarbital, and the other 5 patients were taking a combination of 3 or 4 drugs. None of them was on monotherapy 15 .…”

“…In 9 (45%) cases, the cause of death was pulmonary edema in 8 and hemorrhage in 1. Terrence et al related that among 8 SUDEP patients, 2 had cerebral edema as a postmortem finding and all of them had lung weights that uniformly exceeded the expected value, with gross evidence of pulmonary hemorrhage and edema 15 .…”

“…However, the pulmonary edema indicates that the lethal event in the unexpected death of epileptics is not instantaneous but rather takes time to develop 15 .…”

Bradicardia como manifestação epiléptica em epilepsia temporal: relato de caso

“…A identificação de crise epiléptica causando arritmia cardíaca é necessária, pois implica em terapêutica específica. A identificação de anormalidades cardiovasculares relacionadas a crises epilépticas, levando a distúrbios do ritmo cardíaco e função pulmonar, é importante pois estas podem ser causa de morte súbita em pacientes epilépticos [5][6][7][8]24 .…”

“…Entre estes, alterações da frequência e do ritmo cardíaco podem ser encontradas. Estudos têm demonstrado alterações cardiovasculares durante ou imediatamente após crises epilépticas, experimentalmente e em pacientes com várias formas de epilepsia [1][2][3][4][5][6] .…”