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Ependymal changes in sudden infant death syndrome
1Neurological Tissue Bank, Hospital Clínico-University of Barcelona, Spain.
Abstract:
The ependyma may befall a variety of pathogenic noxae during fetal life, resulting in histological changes which may persist after birth but are without clinical manifestations. Eight of a series of 19 children who died suddenly and unexpectedly, where no explanation as to the cause of death was found at autopsy, were shown to have diverse histological features involving the ependyma. Five micrometer paraffin-embedded brain tissue sections including frontal, temporal, occipital, and ventricular horns as well as the fourth ventricle were stained with hematoxylin-eosin (H&E) and luxol fast blue (LFB). Immunohistochemical stains using antibodies to glial fibrillary acidic protein (GFAP), vimentin and S-100 were also performed. Findings included areas of denuded and/or desquamated ependyma, rosettes in different stages of formation, vacuoles and/or pseudocysts, inflammatory changes consisting in macro- and microglial nodules in the subependymal layer, and gliosis. Chronic brain edema was seen in 4 cases. Our findings indicate that ependymal changes in sudden infant death syndrome (SIDS) cases belong to the prenatal or early postnatal period, thus providing, indirectly, a morphological substrate for the previous existence of a noxa that may also affect other CNS areas, and thus being in the position to produce cardiorespiratory control dysfunction.
Insights
Histological changes in the ependyma were observed in infants with sudden infant death syndrome (SIDS). These prenatal or early postnatal changes may indicate a neurological basis for cardiorespiratory dysfunction.
Area of Science:
- Neuropathology
- Pediatric Pathology
- Histology
Background:
- The ependyma can be affected by prenatal insults, leading to persistent histological changes.
- Sudden Infant Death Syndrome (SIDS) often lacks a clear autopsy explanation.
Purpose of the Study:
- To investigate the presence and nature of ependymal histological changes in SIDS cases.
- To determine if these changes correlate with potential underlying neurological mechanisms for SIDS.
Main Methods:
- Examination of paraffin-embedded brain tissue from 19 SIDS cases using Hematoxylin-Eosin (H&E) and Luxol Fast Blue (LFB) stains.
- Immunohistochemical analysis for glial fibrillary acidic protein (GFAP), vimentin, and S-100.
- Histological evaluation included assessment of ependymal integrity, glial nodules, gliosis, and brain edema.
Main Results:
- Diverse ependymal histological features were identified in 8 of 19 SIDS cases.
- Observed changes included denuded/desquamated ependyma, rosettes, vacuoles/pseudocysts, subependymal inflammatory nodules, and gliosis.
- Chronic brain edema was present in 4 cases.
Conclusions:
- Ependymal changes in SIDS are likely prenatal or early postnatal in origin.
- These findings suggest a potential morphological substrate for neurological dysfunction affecting cardiorespiratory control in SIDS.
- The observed changes may indicate a prior noxa impacting central nervous system (CNS) areas.