ABSTRACT
Examination of the nervous system forms a critical part of the autopsy examination of any infant who dies, whether suddenly and unexpectedly or following recognized illness.
The cause of sudden infant death is not always proximate insult or disease; pre-existing diseases of, or damage to, the nervous system may cause sudden death. Babies with neurological disease, for example, are more prone to aspiration of feeds and to epilepsy. Even quite extensive congenital brain damage acquired in utero or at the time of birth may not present clinically until months or years later, while still having the potential to cause sudden death. It may be that a ‘second insult’ is required, for example very mild brain malformation (microdysgenesis) is seen in patients with epilepsy but may not cause seizures until there is another insult such as trauma. Similarly, babies with metabolic or mitochondrial disease may become profoundly unwell and die when challenged by a respiratory infection. In these babies careful examination of skeletal muscle with histochemistry and review of pre-mortem biochemistry is necessary if an accurate diagnosis is to be made. Chronic subdural haemorrhage may go quite unrecognized for weeks or months until discovered by routine head circumference measurement or even by parental observation of increasing head size.
