Background: A ruptured intracranial aneurysm is the main cause of non-traumatic subarachnoid hemorrhage (SAH). Many studies have described the clinical outcomes for patients admitted to the hospital with SAH and its potential for causing sudden death before the patients receive medical attention.

We undertook this study to highlight Medico-legal investigation of fatal cases of aneurismal subarachnoid hemorrhage in patients who died before receiving medical attention.

Cases Reports: This is a 3-year retrospective study of 6 cases (4 females and 2 male) of sudden death from rupture of intracranial aneurysms, dying few hours after beginning of symptoms, which necessitated an autopsy at the Department of Legal Medicine of Ibn Rochd University Hospital of Casablanca.

In all cases autopsy revealed a massive SAH, which was due to a rupture of aneurysm of a cerebral artery sitting in the Willis polygon in four cases and confirmed by histopathological examination in two cases.

Aneurysmal rupture can occur at rest or as a result of stress or physical workout. Therefore, the age of patient, the anatomic location and size of the aneurysms as well as the extent of subarachnoid hemorrhage, are all likely to be important determinants of the case fatality rate.

The post mortem histopathological examination can be useful in identification of arterial abnormalities, which may sometimes be difficult to recognize macroscopically.

Conclusion: A subarachnoid hemorrhage is a life-threatening type of stroke with a 40% risk of death. The higher fatality and sudden symptoms have a great potentional for been misconstrued as a medico-legal case. Clinicians should therefore recognize this condition and maintain a higher index of suspicion for it to avoid unnecessary accusations.

Keys words: Brain aneurysm, rupture, subarachnoid hemorrhage, sudden death.

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