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Sudden natural death outside the heart

  • Topic

Brain haemorrhage, pulmonary embolism, epilepsy, asthma, aortic rupture and other diseases also cause sudden death; the autopsy looks for them.

Updated

What it is

Although most sudden natural deaths are cardiac, a substantial share have another origin. In the brain, subarachnoid haemorrhage from a ruptured aneurysm and intracerebral haemorrhage, and sudden unexpected death in epilepsy (SUDEP), which each year affects about one in a thousand people with epilepsy, more so those with frequent tonic-clonic seizures, especially at night. In the chest, massive pulmonary embolism, severe asthma and aortic dissection or rupture. In the abdomen and pelvis, haemorrhage such as a ruptured ectopic pregnancy or gastrointestinal bleeding. Fulminant infections, such as meningitis and sepsis, and anaphylaxis complete the list. In some series, sudden deaths from neurological, metabolic or toxic causes occur at younger ages than cardiovascular ones.

Key facts

  • Subarachnoid haemorrhage: look for the aneurysm in the circle of Willis in the fresh brain, before the blood is washed away.
  • Pulmonary embolism: see the thrombus in the pulmonary arteries in situ and look for its source in the deep veins of the legs and pelvis.
  • Asthma: hyperinflated lungs that do not collapse and mucus plugs in the bronchi; histology shows the inflammation.
  • SUDEP: the person is usually found in bed, often face down; there may be a bitten tongue; antiseizure drug levels are measured.
  • Ruptured ectopic pregnancy: haemoperitoneum in a woman of childbearing age; always examine the tubes and uterus.
  • Anaphylaxis: findings are non-specific, such as laryngeal oedema; the history of exposure is key.

Next step: what to do and document

  • Ask witnesses and relatives about previous symptoms: sudden headache, breathlessness, chest pain, seizures, asthma or pregnancy.
  • In a person with epilepsy found dead, record the position, signs of a seizure and the medicines they were receiving, and keep the containers.
  • If there is no known, sufficient natural cause, do not certify: inform the judicial police for a medico-legal autopsy.
  • Write on the certificate the disease that started the chain (for example, a ruptured aneurysm), not the final mechanism.
  • If the cause may be inherited, such as familial aneurysms or thrombophilia, advise the family.
  • Decree 786 of 1990, art. 6(e): the medico-legal autopsy is mandatory in other deaths whose cause is not clear.
  • The death certificate in RUAF-ND and the sequence of causes are covered on the death certificate page.
  • Official text checked on 2026-11-13 at funcionpublica.gov.co.

Test yourself

Think of the answer, then tap the question to see it.

What is SUDEP?

The sudden unexpected death of a person with epilepsy, with no status epilepticus and no other cause at autopsy and toxicology.

Which factor raises SUDEP risk the most?

Frequent tonic-clonic seizures, especially at night, together with living alone and drug-resistant epilepsy.

Where is the source of a massive pulmonary embolism sought at autopsy?

In the deep veins of the legs and pelvis.

Which non-cardiac cause of sudden death should be sought in a young woman with haemoperitoneum?

A ruptured ectopic pregnancy.

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Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.

Sources: Sudden death in the emergency department: A comprehensive 8-year study integrating clinical and autopsy data (Turkish Journal of Emergency Medicine (PMC), 2025); Current perspectives in sudden unexpected death in epilepsy (SUDEP): epidemiology, research approaches and pathways to prevention (Neurological Research and Practice (PMC), 2026); Sudden death in young persons with uncontrolled asthma--a nationwide cohort study in Denmark (BMC Pulmonary Medicine (PMC), 2015); Decreto 786 de 1990: autopsias clínicas y médico-legales y viscerotomías (compilado en el Decreto 780 de 2016) (Función Pública, Gestor Normativo, 1990).

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