title: Sudden unexpected death owing to unilateral medial medullary infarction with early involvement of the respiratory center.
abstract: A 64-year-old woman was found dead in her home. At autopsy, although relatively fresh bruises were found on her body, no lethal injury was observed in an internal observation. Mild edematous swelling of the right half of the medulla oblongata was observed. There was acute medial medullary infarction (MMI), which mainly involved the nucleus hypoglossi, medial lemniscus, hypoglossal root, inferior olivary nucleus, and pyramidal tract. Subacute infarction of the lower part of the cerebellum was also found, and severe atherosclerosis of the right vertebral artery containing thrombi was found as the culprit lesion. Immunohistochemistry using amyloid precursor protein (APP) was positive in neuronal tissue in the nucleus ambiguus, despite not showing coagulative necrosis in the nucleus. Therefore, acute ischemic necrosis of the nucleus ambiguus, which is considered to be a component of the dorsal respiratory group, may be a significant finding for her expected death. Immunohistochemistry of APP may be useful for confirming the precise extent of acute ischemia in brain stem infarction, such as unilateral MMI.
authors: Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
authors: Yukiko
authors: Y
authors: Hata
authors: Department of Neurology, Toyama University Hospital, Toyama, Japan.
authors: Koji
authors: K
authors: Yoshida
authors: Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
authors: Koshi
authors: K
authors: Kinoshita
authors: Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan. Electronic address: nishida@med.u-toyama.ac.jp.
authors: Naoki
authors: N
authors: Nishida
mesh_terms: D001344:Autopsy; D020526:Brain Stem Infarctions / Q000150:complications* / Q000473:pathology; D016757:Death, Sudden, Cardiac / Q000209:etiology*; D005260:Female; D006801:Humans; D008526:Medulla Oblongata / Q000473:pathology*; D008875:Middle Aged; D012125:Respiratory Center / Q000473:pathology*
keywords: Amyloid precursor protein; Cerebral infarction; Medulla oblongata; Nucleus ambiguus; Vertebral artery