Best Post of July '09: Behold! Phineas Gage revealed!

The next in our series of "Best Posts of the Month" is from July 30, 2009:

The Los Angeles Times reports that a daguerreotype depicting Phineas Gage has been discovered. In the next issue of the Journal of the History of the Neurosciences, an article establishing the identity of the man holding an iron rod (see photo above) is that of Mr. Gage. This is the only known photograph of perhaps the most legendary neurology patient in history. To illustrate the executive function orchestrated by the prefrontal lobes, medical students throughout the country are told the story of the railroad construction foreman Phineas Gage, who, in 1848, suffered an accident on the job which resulted in a 13-pound iron rod shooting through the front of his brain. Gage survived the accident, and lived 11 years more. But he was never the same, exhibiting "frontal release" signs characterized by disinhibition and impulsivity.

The photograph was discovered by Jack and Beverly Wilgus, a couple from Massachusetts who owned the photograph for 30 years, thinking it depicted a whaler holding a harpoon. When they posted the picture online, an anonymous tipster suggested it might be Gage. The LA Times article continues the story: "Intrigued, the Wilguses compared their image to that of a life mask at Harvard Medical School's Warren Anatomical Museum and found it could be superimposed perfectly, with scars lining up correctly. Apparent writing on the metal rod in the image matches writing on Gage's iron rod, which is also in the Warren Museum."

Finally, a simple cartoon depicting the anatomic location of the transentorhinal cortex

In our teaching and in our autopsy reports, we neuropathologists often make reference to the transentorhinal cortex as it is -- in the Braak and Braak staging system -- the region where the earliest Alzheimer pathology appears. I have found it difficult to find a clear illustration of the anatomic location of the transentorhinal cortex in texts or on the internet. However, I came across a nice cartoon of the divisions of the parahippocampal gyrus, including the transentorhinal cortex, in an online presentation by Prof. Jillian Kril of the Pathology Department at the University of Sydney, NSW. Prof. Kril kindly emailed me a copy of the illustration, which is depicted above with the addition of a label for the presubiculum.  Feel free to use this cartoon for teaching purposes with the following credit: Adapted from Harding AJ, Halliday GM, Kril JJ. Variation in hippocampal neuron number with age and brain volume. Cerebral Cortex (December, 1998) 8:710-718.

Neuropathology Blog Initiates Job Listing Feature

I am today initiating an open position list on Neuropathology Blog. In the column to the right, I will be adding neuropathology positions as I become aware of them. I have inaugurated the process by listing three open positions, along with contact information. First, Rush University Medical Center is looking for a neuropathologist to replace the illustrious Dr. Liz Cochran, who has moved to the Medical College of Wisconsin. Secondly, the esteemed Dr. Mark Cohen is looking for a neuropathology colleague at Case Western Reserve University. Finally, Genentech in South San Francisco, CA is looking for a neuropathologist. If you hear of other positions that are available, please write in so that I can add to the list. Good luck to the job seekers. And thanks to Dr. Peter Cummings for suggesting this feature!

Epidermal nerve fiber density assessment: probably not worth doing in-house

About a month ago, I addressed the issue of skin biopsies for patients with peripheral neuropathy to assess for nerve fiber density. Since that post, I have heard that this test is not something to be taken lightly. Dr. Tom Smith (pictured) of the University of Massachusetts had this to say about the test: "Basically, to assess fiber density correctly in these skin biopsies, you need a considerable investment in technology (e.g. a confocal microscope, morphometric software program, etc) and technician training -- do you really have time to sit and count fibers?" Dr. Smith went on to say that in his opinion, there is a rather high initial investment for a relatively small volume of cases. Since a few university labs and Therapath already offer this service, its probably wise for most institutions of small or medium size to outsource this particular test. Finally, might these skin biopsies ultimately turn out to be a fad? Do these biopsies really provide useful information beyond what one could gain from clinical and electrophysiologic exam? Given these concerns, I'll likely recommend Therapath to any clinician looking for an epidermal nerve fiber density assessment.