Histopathologic and Morphometoric Studies of the Brain Stem and Cerebellum in Sudden Infant Death Syndrome

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Determining the cause of death by SIDS is one of the most important tasks at issue in forensic medicine and pediatrics. We focused on the in fant's brain, and examined the following on 20 cases of SIDS and 13 cases (reference group) of death from other causes.By a three-dimensional image analysis, (A) the capacity of posterior cranial space and (B) the capacity of its lower part, (a) the volume of the whole of cerebellum, pontes and medulla oblongata and (b) the volume of medulla oblongata were measured. As a result, all the capacities and volumes were found to increase as the infants aged. When these values were compared among same-month age groups (2-11 months old), with the exception of B,the values were smaller with SIDS cases than the reference group. In contrast, the value of B was bigger with the SIDS cases. These results indicate, not only immaturity of the cranium and the brain, but also the cranium's structural problem of vulnerability to invagination of cerebellar tonsil. If this happens, it could trigger the perfusion disorder of cerebrospinal fluid and the rise in intracranial pressure, which in turn might affect functions of the respiratory center.Next, by a two-dimensional image analysis, (1) the thickness of the external granular layr of the cerebellar cortex, (2) the number of small granule cells, and (3) the cavity around blood vessels were measured, and compared among the same-month age groups. As a result, (1) and (2) showed immaturity of the brain among SIDS cases, and (3) showed evidence of the aforementioned rise in intracranial pressure (brain edema).