The People have Spoken!

The poll results are in, and Little Rock wins (see graph of results below). I have forwarded the results of the poll to Jeffrey A. Golden, M.D., president of the American Association of Neuropathologists for his consideration. Thanks to everyone who participated!

New Edition of Greenfield's Neuropathology to be issued this spring

According to Amazon.com, the new edition of Greenfield's Neuropathology (a two-volume set with accompanying CD) is scheduled to come out April 25, 2008. You can pre-order this, the most comprehensive of neuropathology textbooks, on Amazon for $599 by following this link:
http://www.amazon.com/Greenfields-Neuropathology-Set-CD-Book/dp/0340906820/ref=pd_bbs_sr_1?ie=UTF8&s=books&qid=1201543368&sr=8-1
Dr. David N. Louis of Mass General in Boston is one of the authors.

Urgent Bulletin to Neurologists about patients working with the heads of pigs!

The CDC has sent out an urgent notice to be on the lookout for patients who work in pig processing plants complaining of pain, numbness, and tingling in the extremities. In the fall of 2007, clinicians at the Mayo Clinic in Rochester, Minnesota notified the Minnesota Department of Health of an unusual cluster of 12 patients with inflammatory neuropathy among workers at a pork processing plant in Minnesota. An initial investigation has revealed that they all have worked in the same area of the plant where the heads of the pig are processed. Additional patients have been identified in Indiana, among workers in a similar plant. At this point an etiologic agent has not been identified.
The CDC bulletin reads: “neurologists who have diagnosed patients with peripheral neuropathy, myelopathy, or a mixed clinical presentation of peripheral / central (and, more specifically, myelopathic) involvement in persons with exposure to pig butchering or processing during the past year are asked to report this information to their state health department, and contact the CDC at 770-488-7100.”

The Grand Poobah of Rhode Island Neuropathology!

Every so often on neuropathologyblog, I like to profile a prominent neuropathologist. Today’s feature is the illustrious Dr. Edward G. Stopa. Ed got his undergraduate and medical degrees at McGill University in Montreal. After residency in anatomic pathology and neuropathology at Brigham and Women’s Hospital in Boston, where he learned at the knee of people like Dr. Douglas Miller, he served on the faculty at Tufts and SUNY-Syracuse. Finally, he ended up at Rhode Island Hospital, an affiliate of Brown University, where he served as my mentor during my own neuropathology fellowship. I would encourage anyone interested in doing a neuropathology fellowship to look into Dr. Stopa’s program. I would also add that Providence, Rhode Island is quite a nice place to live!

Natural History of vertibrobasilar dolichoectasia

Vertibrobasilar dolichoectasia (VBD) is enlargement, elongation, and tortuosity of the basilar artery. Passero and Rossi have an article in the current issue of Neurology discussing the natural history of this condition. The outcomes from VBD ranges from completely asymptomatic to compression of the brainstem or cranial nerves, obstructive hydocephalus, ischemia in the vertibrobasilar artery distribution, and intracranial bleeds of various kinds. So the natural history depends on the condition at diagnosis and on its evolution. (Source: Passero SG and Rossi S. 'Natural history of verterbrobasilar dolichoectasia' Neurology, Jan 1, 2008. Vol 70, number 1. Pages 66-72).

Limb Apraxia in a case of corticobasal degeneration

This week I'll be doing a brain cutting on a patient with a clinical diagnosis of corticobasal degeneration. What made the clinical diagnosis a little easier in this case is the fact that the patient exhibited "alien limb" phenomenon of the left arm. Limb apraxia was also present. Apraxia is a disorder of skilled, learned, purposeful movement. CBD is is one of the few disorders in which limb apraxia can appear in the history (ie, patients are often aware of the apraxia).

Primary Angiitis of the CNS: The Elvis Presley of Neurology

Dr. David Hellmann of Johns Hopkins, in the current Clinical Neurology News, is quoted as saying that primary angiitis of the central nervous system (PACNS) “is the Elvis Presley of neurology… CNS vasculitis-like illness is more often thought to be present than actually present”. In fact, he says, CNS vasculitis accounts for only 1% of all biopsy-proven cases of vasculitis. Interestingly, very few patients with PACNS describe a stroke-like presentation. Rather, the most common presentation is insidious cognitive decline with headache. A biopsy is required for diagnosis, and cyclophosphamide without a definitive biopsy-proven diagnosis is not recommended. Yet again, the neuropathologist is the key!

By Popular Demand: The Entire List of Neuropath@Nite Frozen Room Rules

1. You, and you alone, know if you need more tissue to make an intraoperative diagnosis.
2. When misdiagnosing a lesion, always strive to do the least amount of harm!
3. Lipid-laden macrophages are very strong evidence against the presence of a glioma.
4. Rule number 2 trumps rule number 3 (explained as: “It is easier to reoperate on a patient with a glioma initially misdiagnosed as a tumor-like demyelinating lesion, than replace resected demyelinated tissue initially misdiagnosed as gliomas.”)

Neuropath@Nite Rule #2

In October of 2007, I attended a seminar at the Annual CAP meeting entitled 'Neuropath at Nite - Staying Cool in the Frozen Room'. The session was conducted by Drs. Mark Cohen of Case Western and Joe Parisi of the Mayo Clinic. I was just reviewing the handout and noted the second rule of staying cool in the frozen room (as conceived by Dr. Cohen): "When misdiagnosing a lesion, always strive to do the least amount of harm!" The application of this rule is explained as follows: " 'Tis better that a patient with a malignant glioma receives a few doses of antibiotics than a patient with a brain abscess be left untreated." Wise and worthy words......

The forgotten herniation

When grossly describing the autopsied brain, we all comment on uncal, cerebellar tonsillar, and subfalcine herniation -- usually as a pertinent negative. But few of us mention external herniation, which can be more colorfully referred to as 'fungus cerebri'. This results from protrusion of brain parenchyma from the cranial cavity when there is a traumatic or surgical defect in the skull.