Sudden and unexpected death is also seen in association with hydrocephalus. Here, the patient will usually have a long history of hydrocephalus, often with a shunt procedure performed in the past. The patient appears to be asymptomatic, then suddenly dies. At autopsy, one will find chronic

Figure 3.13 (continued) Meningococcemia. (C) Bilateral acute hemorrhagic necrosis of adrenals.

hydrocephalus, generally without any acute process. Such deaths are apparently a manifestation of the "final straw that broke the camel's back." These individuals were apparently borderline stabilized as to intracranial pressure, when some minor physiological change sufficient to raise the intracranial pressure caused death.

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