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Re: Some cases of unexpected sudden death are associated with tumors

I read with interest the report of Morentin et al[1] describing unexpected sudden death occurring between the ages of 1 and 19 years. Of the 34 cases described eleven remained unexplained. The authors failed to mention whether neuropathologic examination was performed in the eleven unexplained cases, and why such examination is essential.

Tumors and infarctions of the brainstem, especially the medulla oblongata, have been discovered at postmortem examination in some cases of unexpected sudden death where death could not otherwise be explained. In the age group studied by the authors most reported cases have involved tumors[2][3] as is also true for infants[4] and young adults .[3][5] In the elderly most reported cases have described infarctions.[6-12]

The mechanism of unexpected sudden death associated with brainstem tumors and infarctions is unknown,[9][11-13] as is the manner in which the mechanism may vary with age of the patient, type of pathology, or specific location within the brainstem.

References
(1) Morentin B, Garamendi PM, Aguilera B, Suarez-Mier MP. Sudden unexpected non-violent death between 1 and 19 years in north Spain. Arch Dis Child 2000;82:456-61.

(2) Nelson J, Frost JL, Schochet SS. Sudden, unexpected death in a 5- year-old boy with an unusual primary intracranial neoplasm: ganglioglioma of the medulla. Am J Forensic Med Pathol 1987;8:148-52.

(3) Gleckman AM, Smith TW. Sudden unexpected death from primary posterior fossa tumors. Am J Forensic Med Pathol 1998;19:303-8.

(4) Matturri L, Ottaviani G, Rossi L. Sudden and unexpected infant death due to an hemangioendothelioma located in the medulla oblongata. Adv Clin Path 1999;3:29-33.

(5) Opeskin K, Ruszkiewicz A, Anderson R McD. Sudden death due to undiagnosed medullary-pontine astrocytoma. Am J Forensic Med Pathol 1995;16:168-71.

(6) Jaster JH, Porterfield LM, Bertorini TE, Dohan FC Jr, Becske T. Cardiac arrest following vertebrobasilar stroke. J Tenn Med Assoc 1995;88:309.

(7) Jaster JH, Porterfield LM, Bertorini TE, Dohan FC Jr, Becske T. Stroke and cardiac arrest [letter]. Neurology 1996;47:1357.

(8) Jaster JH, Smith TW. Arrhythmia mechanism of unexpected sudden death following lateral medullary infarction. Tenn Med 1998;91:284.

(9) Jaster JH, Smith TW, Gleckman AM. A medullary syndrome characterized by wild arm ataxia [letter]. Neurology 2000;55:321.

(10) Jaster JH. Unexpected sudden death after lateral medullary infarction. J Neurol Neurosurg Psychiatry [letter]. [In press]

(11) Carod Artal FJ, Cuadrado Perez ML, Gonzalez Gutierrez JL, Egido Herrero JA. Trastorno autonomico y muerte subita en un caso de sindrome de Wallenberg. Neurologia 1997;12:46-7.

(12) Andres del Barrio MT, De las Heras Revilla V, Martin Estefania C, Gonzalez, Gutierrez JL. Fallo respiratorio secundario a disautonomia en el infarto bulbar lateral. Neurologia 1998;13:312-13.

Send letter to journal:
Re: Re: Some cases of unexpected sudden death are associated with tumors

Dear Editor:

As Jaster mentioned in his letter,[1] some cases of sudden unexpected death in children and adolescents associated with tumors of the brainstem have been reported. Most of these tumors sized more than 2 cm.[2][3] Sudden unexplained death (similar to sudden infant death syndrome (SIDS)) is diagnosed when no cause of death is found after an exhaustive postmortem investigation including a complete autopsy, toxicological analysis and review of the medical history.

Concerning our report,[4] in all cases a complete gross and histological examination was performed and in none of the 11 unexplained deaths any brainstem or other neuropathological lesion was observed.

Benito Morentin
Instituto Vasco de Medicina Legal
Buenos Aires, 4-6.
Bilbao (Basque Country). E- 48001.
Fax: + 94 401 66 27

References
(1) J Howard Jaster. Some cases of unexpected sudden death are associated with tumors [eLetter]. Arch Dis Child 29 November 2000.

(2) Opeskin K, Ruszkiewicz A, Anderson R McD. Sudden death due to undiagnosed medullary-pontine astrocytoma. Am J Forensic Med Pathol 1995;16:168-71.

(3) Gleckman AM, Smith TW. Sudden unexpected death from primary posterior fossa tumors. Am J Forensic Med Pathol 1998;19:303-8.