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Witnessed sleep-related seizure and sudden unexpected death in infancy: a case report

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Abstract

Witnessed reports of sudden death are rare, but critical to deciphering its mechanism(s). We report such a death in a seemingly healthy 8-month-old boy in whom seizures and respiratory distress in the prone position were witnessed upon discovery during a sleep period. Following cardiopulmonary resuscitation, anoxic encephalopathy resulted in “brain death” and withdrawal of life support after 2 days. The autopsy did not reveal a primary anatomic cause of death. Metabolic evaluation failed to uncover an inborn error of ammonia, amino, organic, or fatty acid metabolism. Seizures in this case may have been secondary to cerebral hypoxia–ischemia complicating cardiorespiratory arrest of unknown etiology. Yet, they may represent the first manifestation of idiopathic epilepsy, triggering cardiopulmonary arrest, analogous to the terminal events postulated in sudden and unexplained death in epilepsy. This report alerts the forensic community to the possibility that sudden and unexplained death in infants may be due to seizures.

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Acknowledgments

We deeply appreciate the parents’ courage in sharing their experience of the loss of their son in the hopes of advancing basic knowledge about sudden and unexpected death in infancy. We are grateful for the helpful comments of Drs. Joseph J. Volpe and Eugene E. Nattie in manuscript preparation. This study was supported by the Cooper Trewin Foundation for Sudden Unexplained Death in Childhood, program in Sudden and Unexpected Death in Pediatrics, Boston Children’s Hospital, MA, Eunice Kennedy Shriver Institute of Child Health and Development (P01-042774441) (HCK), and Intellectual and Developmental Disabilities Research Center, Boston Children’s Hospital, MA (P30-HD18655).

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Authors and Affiliations

  1. Department of Pathology, Boston Children’s Hospital and Harvard Medical School, Enders Building 1112, 300 Longwood Avenue, Boston, MA, 02115, USA

    Hannah C. Kinney, Anna G. McDonald & Megan E. Minter

  2. Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Gerard T. Berry & Richard D. Goldstein

  3. Department of Neurology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA

    Annapurna Poduri

Authors
  1. Hannah C. Kinney
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  2. Anna G. McDonald
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  3. Megan E. Minter
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  4. Gerard T. Berry
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  5. Annapurna Poduri
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  6. Richard D. Goldstein
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Correspondence to Hannah C. Kinney.

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Kinney, H.C., McDonald, A.G., Minter, M.E. et al. Witnessed sleep-related seizure and sudden unexpected death in infancy: a case report. Forensic Sci Med Pathol 9, 418–421 (2013). https://doi.org/10.1007/s12024-013-9448-0

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  • DOI: https://doi.org/10.1007/s12024-013-9448-0

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