Sudden death due to central alveolar hypoventilation syndrome (Ondine's curse) in a 39-year-old woman with heterotopia of the inferior olive

Ondine's curse: myth meets reality

Ondine's curse is one of the most enchanting mythical tales in the field of Medicine. The nymph Ondine was an immortal water spirit who became human after falling in love for a man, marrying him, and having a baby. In one of the versions of the tale, when she caught her husband sleeping with another woman, she cursed him to remain awake in order to control his own breathing. During the 19th century, the rare syndrome characterized by loss of autonomic breath control, while voluntary respiration remains intact, was cleverly named “Ondine's curse”. Nowadays, the term Ondine's curse is usually associated with congenital central hypoventilation syndrome; however, in medical literature, it also designates several respiratory disorders. Here, we present a review of the myth focused on history, arts and medicine.

Cerebellar heterotopia of infancy in sudden infant death syndrome: an observational neuropathological study of four cases

Sudden infant death syndrome (SIDS) is the sudden unexpected death of an infant < 1 year of age that remains unexplained after comprehensive workup including complete autopsy and investigation of the circumstances of death. The triple risk hypothesis posits that SIDS results as a combination of both intrinsic and extrinsic factors on the background of a predisposing vulnerability. Neuropathological examination in the past has focussed mainly on the brainstem as the major player in respiratory control, where subtle findings have been linked to the chain of events leading to death in SIDS. The cerebellum has received less attention, probably due to an assumed negligible role in central cardiorespiratory control. We report four cases of SIDS in which neuropathological investigation revealed cerebellar heterotopia of infancy, a distinct malformation of the cerebellum, and discuss the potential impact of this condition on the aetiology and pathogenesis of SIDS.

Medicine in the future - with subspecialists in medullary neurology and brain dentistry

The solitary tract nucleus of the medulla with its limited watershed vascular capacity may occasionally be the focus of transient ischemia caused by the increased metabolic demands associated with frequent and intense neuronal stimulation from other organs and other parts of the brain. Case reports have suggested that these ischemic changes may sometimes result in the initiation of intense autonomic discharges, which can occasionally be fatal. Therapeutic interventions for the medulla oblongata are hampered by its limited accessibility. Systemically administered pharmaceuticals may have some usefulness in future years. Previous experience with vagus nerve stimulation in the treatment of epilepsy suggests that it may have some usefulness in stabilizing medullary autonomic discharges. Computerized electronic stimulation of other cranial nerves may be helpful as well, especially the chorda tympani nerve, and may be most easily accomplished from implanted dental appliances, especially molar modules, transmitting signals via secondary transmitters procedurally placed on cranial nerves. Future technology may enable wireless signaling from the implanted dental appliance to the secondary transmitter placed at the nerve site. By the year 2050 subspecialists in medullary neurology and brain dentistry may use computerized electronic stimulation of cranial nerves to prevent sudden unexpected death and treat “chest pain from the brain”.

Sudden adult death

In the investigation of sudden death in adults, channelopathies, such as long QT syndrome, have risen to the fore in the minds of forensic pathologists in recent years. Examples of these disorders are touched upon in this review as an absence of abnormal findings at postmortem examination is characteristic and the importance of considering the diagnosis lies in the heritable nature of these conditions. Typically, a diagnosis of a possible channelopathy is evoked as an explanation for a 'negative autopsy' in a case of apparent sudden natural death. However, the one potential adverse effect of this approach is that subtle causes of sudden death may be overlooked. The intention of this article is to review and discuss potential causes of sudden adult death (mostly natural) that should be considered before resorting to a diagnosis of possible channelopathy. Nonetheless, it becomes apparent that many of the potential causes of sudden death can have a genetic basis. Thus, it becomes an important consideration that there may be a genetic basis to sudden death that extends beyond the negative autopsy.

The mystery of sudden death: mechanisms for risks

This review addresses the possible overlapping mechanisms that may apply to the risk of sudden unexpected death occurring in epilepsy and in cardiac disease. It explores the interaction between the central and peripheral autonomic nervous systems and the cardiopulmonary systems. Included is a discussion of the potential interactive role of genetically determined subtle cardiac risk factors for arrhythmias with a predisposition for seizure-related cardiac arrhythmias. We address the possible mechanisms that are operant in producing both epileptogenic and cardiogenic arrhythmias. Finally, we speculate about potential preventive measures to minimize the risk of both sudden unexpected death in epilepsy and sudden cardiac death.