We read with interest the report of Biondo et al. describing neuropathologic changes in 23 infants who experienced sudden infant death syndrome (SIDS). The authors focused on the solitary tract nuclei, an anatomic location that has increasingly been considered to harbor subtle abnormities, which may relate causally to the unexpected sudden death of infants in whom no other cause of death can be found.
Strikingly absent in these cases is premonitory neurologic dysfunction. A specific etiologic mechanism remains obscure, but related significant circumstances are considered to include developmental immaturity and hypomyelination together with ischemic/hypoxic injury.