Symmetrical selective neuronal necrosis in solitary tract nuclei

Dear Sir, In our paper “Solitary tract nuclei in acute heart failure” (De Caro et al. 2000) we reported symmetrical selective neuronal necrosis in the solitary tract nuclei in five adults with short survival intervals after acute heart failure. We suggested that given the limited extent of the symmetric medullary lesions, cerebral ischemia could not be the only factor responsible for them. In fact, the absence of lesions of other brainstem nuclei accounts for the selective vulnerability of the neurons of the solitary tract nuclei, which may be explained with reference to vascularization of the medullary tegmentum. Furthermore, we suggested that dendritic lesions indicate that cell death had an excitotoxic component (Olney 1972) that can be ascribed to hyperexcitation of neurons in the solitary tract nuclei in the post-ischemic period.