Bulbo-spinal pathology in neurocardiac sudden death of adults: a pragmatic approach to a neglected problem

This paper gives an overview on the neurocardiopathy of reflexogenic sudden death in adults, focusing on the bulbo-spinal cardiovascular-respiratory centers and which is reminiscent of the recent findings in sudden infant death syndrome. The preeminent life-threatening derangements of the oxygen-conserving cardio-inhibitory reflex (dive-reflex and its subsets) were reconsidered in histopathology, together with bulbo-spinal sympathovagal abnormalities and possible underlying arrhythmogenic QT interval prolongation. A simplified methodology for the microscopical examination of the brain stem and upper thoracic spinal cord is suggested. The aim is to facilitate the pathologist’s approach to a lamentably neglected, yet fundamental topic in the far-reaching domain of sudden cardiac death with no evidence of cardiovascular respiratory disease.