Sudden unexpected death owing to unilateral medial medullary infarction with early involvement of the respiratory center

Medial medullary infarction (MMI) is a vascular occlusion in the medulla oblongata leading to certain constellations of neurological symptoms and seriously affecting the patient. Effective evidence-based treatment of severe dysphagia as sole symptom of MMI has not yet been reported. This case study aims to report successful effects of evidence-based therapy based on findings of dysphagia symptoms and pathophysiology of swallowing by flexible endoscopic evaluation of swallowing (FEES) in severe isolated dysphagia after MMI. FEES was performed to evaluate swallowing pathophysiology and dysphagia symptoms in a 57-year-old male with severe dysphagia after MMI. On the basis of FEES findings, simple and high-frequent evidence-based exercises for improvement of swallowing were implemented: thermal stimulation of faucial arches, Jaw Opening Exercise, and Jaw Opening Against Resistance. After 7 weeks of high-frequent evidence-based therapy and regular FEES evaluation the patient was set on full oral diet with no evidence of aspiration risk. In a first case report of isolated dysphagia in MMI our case illustrates that high-frequent evidence-based dysphagia therapy in combination with FEES as the method to evaluate and monitor swallowing pathophysiology can lead to successful and quick rehabilitation of severely affected dysphagic patients.

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A patient with bilateral medial medullary infarction: Clinical and magnetic resonance imaging findings

Interdisciplinary Neurosurgery ◽

10.1016/j.inat.2021.101126 ◽

2021 ◽

Vol 25 ◽

pp. 101126

Author(s):

Rikitaro Sako ◽

Satoshi Yamamoto ◽

Kotaro Takeda ◽

Masahiro Wakatabi ◽

Minoru Daira ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Imaging Findings ◽

Resonance Imaging ◽

Medial Medullary Infarction ◽

Medullary Infarction

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A forensic autopsy case: sudden unexpected death due to cardiac inflammatory myofibroblastic tumor

Legal Medicine ◽

10.1016/j.legalmed.2021.101931 ◽

2021 ◽

pp. 101931

Author(s):

Shoken Suzuki ◽

Maki Ohtani ◽

Yuhei Matsuo ◽

Makoto Yoshida ◽

Akiteru Goto ◽

...

Keyword(s):

Inflammatory Myofibroblastic Tumor ◽

Forensic Autopsy ◽

Sudden Unexpected Death ◽

Autopsy Case ◽

Unexpected Death

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Differential Methylation in the GSTT1 Regulatory Region in Sudden Unexplained Death and Sudden Unexpected Death in Epilepsy

International Journal of Molecular Sciences ◽

10.3390/ijms22062790 ◽

2021 ◽

Vol 22 (6) ◽

pp. 2790

Author(s):

Steffan Noe Christiansen ◽

Stine Bøttcher Jacobsen ◽

Jeppe Dyrberg Andersen ◽

Marie-Louise Kampmann ◽

Linea Christine Trudsø ◽

...

Keyword(s):

Dna Methylation ◽

Cardiac Tissue ◽

Heart Diseases ◽

Regulatory Region ◽

Differential Methylation ◽

Sudden Unexpected Death ◽

Diagnostic Challenge ◽

Unexpected Death ◽

Sudden Unexplained Death ◽

Unexplained Death

Sudden cardiac death (SCD) is a diagnostic challenge in forensic medicine. In a relatively large proportion of the SCDs, the deaths remain unexplained after autopsy. This challenge is likely caused by unknown disease mechanisms. Changes in DNA methylation have been associated with several heart diseases, but the role of DNA methylation in SCD is unknown. In this study, we investigated DNA methylation in two SCD subtypes, sudden unexplained death (SUD) and sudden unexpected death in epilepsy (SUDEP). We assessed DNA methylation of more than 850,000 positions in cardiac tissue from nine SUD and 14 SUDEP cases using the Illumina Infinium MethylationEPIC BeadChip. In total, six differently methylated regions (DMRs) between the SUD and SUDEP cases were identified. The DMRs were located in proximity to or overlapping genes encoding proteins that are a part of the glutathione S-transferase (GST) superfamily. Whole genome sequencing (WGS) showed that the DNA methylation alterations were not caused by genetic changes, while whole transcriptome sequencing (WTS) showed that DNA methylation was associated with expression levels of the GSTT1 gene. In conclusion, our results indicate that cardiac DNA methylation is similar in SUD and SUDEP, but with regional differential methylation in proximity to GST genes.

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