Sudden infant death syndrome: increased number of synapses in the hypoglossal nucleus.

The medulla was sampled from nine cases of sudden infant death syndrome (SIDS) and from six age-matched control cases without neurological disease. Morphometric analyses were performed on serial Nissl sections through the hypoglossal nucleus on the left side of the medulla. The total volume of the nucleus and both the numerical density (Nv, cells per mm3) and total number of neurons were measured. Tissue from the remaining hypoglossal nucleus was prepared for electron microscopy using the ethanolic phosphotungstic acid method to stain synaptic contacts. Stereological analyses were performed to determine the Nv and total number of synapses. Total volume of the hypoglossal nucleus was significantly greater (36%) in SIDS cases than in controls. The Nv of neurons was significantly less than in controls (28%), although the total number of neurons did not differ significantly. The mean profile area of motor neuron cell bodies was significantly greater (30%) in SIDS cases, with no differences in the mean profile areas for interneurons or glia. The Nv of synapses did not differ significantly between SIDS cases and controls, although the total number of synapses was greater (61%) in SIDS. These abnormalities in growth indicate a greater volume of neuropil in a hypoglossal nucleus containing a normal complement of neurons. The greater number of synapses in SIDS cases is consistent with a failure to eliminate normally extraneous synapses during early development.