Subacute necrotizing encephalomyelopathy in a neonatal infant.

This infant, born after a normal pregnancy by cesarean section, appeared entirely normal for the first 44 hours of life, at which time she was found to have become completely apneic, suddenly and without known cause. The infant was resuscitated, placed in a respirator, treated energetically but with limited response, and expired 15 days later. At autopsy, bilaterally symmetric lesions were found in the walls of the third ventricle, the periaqueductal gray matter and the floor of the fourth ventricle, characterized by marked destruction of most neural elements, but with a selective preservation of neurons and their processes. The process is interpreted as that of subacute necrotizing encephalomyelopathy. Many of the preserved neurons had reacted by a multiplication of nuclei, as many as 11 being present in a single cell. Binucleated macrophages were also present; There were hypoxic changes as well, with a loss of neurons in the hippocampal gyrus, and with basophilic PAS positive granules in the cytoplasm of many neurons, some containing iron. If resuscitation had failed this would have been considered a "crib death". The possibility exists that some other cases of crib death may be of this nature.