First 2010 CAP Neuropathology Education CD-ROM is released.

I recently received in the mail the College of American Pathologists' excellent Neuropathology Program CD-ROM, the first of two installments for the year. I've written about this product in the past; and I recommend it to trainees, general pathologists, and neuropathologists. Each installment consists of eight cases, four of which are linked by a particular theme. The current edition's theme (the CAP uses the term "symposium") is Masses in the Cauda Equina Region. The symposium introduction is written by Drs. Bette K. DeMasters and Hillary L. Somerset of the University of Colorado Health Sciences Center.(Dr. Somerset is pictured.) Included in the symposium introduction is a handy algorithmic representation for the differential diagnosis of cauda equina lesions. Good stuff!

Best Post of October '09: Should Football Be Illegal?

The next in our series of "Best Posts of the Month" is from October 21, 2009:

Two neuropathologists are prominently spotlighted in an article by Malcolm Gladwell in the October 19 issue of The New Yorker. The article explores a provocative question raised by autopsy results on football players: namely, should football be illegal? Featured are Dr. Ann McKee (pictured), neuropathologist at the Veterans Hospital in Bedford, Massachusetts and Dr. Bennet Omalu, forensic neuropathologist and San Joaquin Valley (CA) chief medical examiner. Drs. McKee and Omalu have done some interesting autopsy work which suggests that the tau-positive chronic traumatic encephalopathy suffered by football players is much more common, even among high school players, than previously realized. As an example, McKee provides photomicrographs from a case of an 18-year-old high school football player and says: "He's got all this tau. This is frontal and this is insular.... This is completely inappropriate. You don't see tau like this in an 18-year-old. You don't see tau like this in a fifty year old."


You might counter that this is simply the result of a few bad-luck hits on the field, but research involving the University of North Carolina football team suggests otherwise. Players at UNC wear impact sensors in their helmets throughout the season. Results from these investigations suggests that even routine hits during practice can add up to cause concussions and, theoretically, set the stage for chronic traumatic encephalopathy. (On the first day of training camp one UNC lineman was recorded as having been hit in the head thirty-one times!)

Back in 1905, Gladwell reports, the question of whether football should be played in our nation's schools was raised to the level of the White House, when President Theodore Roosevelt called an emergency summit to discuss the issue. At the time, a professor at the University of Chicago called football a "boy-killing, man-mutilating, money-making, education-prostituting, gladiatorial sport". And in December of 1905, presidents of twelve prominent colleges met in New York and came within one vote of abolishing the sport at their institutions.

What does this mean for football in America? Nothing. Fans are willing to spend a lot of money to see men slam into each other's heads on the field. But, as a parent, you can do something. You can forbid your son from playing football.

2010 AANP Annual Meeting Program Announced

The preliminary program for the 2010 annual meeting of the American Association of Neuropathologists has been released. The meeting, to be held June 10-13 in Philadelphia, will feature a special day-long course entitled Hereditary Tumor Syndromes of the Nervous System: Clinical, Pathological, and Biological Updates. Of the topics to be covered in that course, I most eagerly anticipate the presentation by Dr. Alexander Judkins (pictured) entitled  "INI1: Syndromes and Diagnostic Neuropathological Applications". Since the World Health Organization has only in recent years recognized Rhabdoid Tumor Predisposition Syndrome and its association with the INI1 gene, it will be interesting to hear Judkins -- a recognized leader in this area of research -- talk about the evolution of this syndrome as a distinct nosologic entity. Also on the agenda is a Presidential Symposium entitled "Big Science" Neuro-Oncology: How can Neuropathologists Play Roles in Large-Scale Clinical, Translational and Basic Research? The Transition to Personalized Medicine. Its heartening to see the AANP addressing one of the key areas of transformation in pathology in the coming decades: personalized medicine. And, of course, the always-popular Diagnostic Slide Session of unknowns makes its return. So far, it looks as though we're in for a stimulating meeting!

Perry Rocks: Arie releases neuropathology music CD

When I first heard about this, I said to myself: "No way. This has got to be a spoof." But its true! Neuropathologist Arie Perry (pictured) has released a music CD called Neuropathology Songs, which can be purchased at his website, which includes free samples of several songs. The song list includes such soon-to-be classics as Acute Meningitis, Craniopharyngioma, and Leukodystophies. Perhaps my favorite tune is Schwannoma, which features the following chorus:

Schwannomas are no mystery; you look for Antoni A and Antoni B

And Verocay bodies will clinch the diagnosis for me
Hyalinized vessels is another clue,
And good encapsulation is a key feature too
To make the diagnosis when the surgeon’s leaning over you
To make the diagnosis when the surgeon’s leaning over you

In the current issue of the journal Brain Pathology, Perry has this to say about the new CD: "For many years, I’ve employed these songs for teaching medical students about common neurological disorders. As word of this practice spread however, I’ve been increasingly asked to include such songs in invited lectures and even to the lay public in a local 'Mini Medical School Course', all associated with extremely positive feedback. I’ve even received requests to share these songs with educators and students from other medical centers, in part prompting me to record these songs professionally."

I blogged about Perry back in September regarding his impending move from Wash U in St. Louis, where he has spent the last 12 years, to the University of California at San Francisco. Perry starts as UCSF's neuropathology chief this summer. I assume they'll be giving him time off to collect his award at the Grammys.

Best Post of September '09 - A Case of Cerebral Baylisascariasis

The next in our series of "Best Posts of the Month" is from September 28, 2009:

A loyal reader sent in this wonderful photomicrograph from a recent case of cerebral Baylisascariasis (click on the picture to see it up close). A cause of eosinophilic meningoencephalitis, infection with Baylisascaris procyonis is typically characterized by necrosis and eosinophilic inflammation. Larvae are often encapsulated within fibrous tissue (reference 1). Although not particularly neurotropic, the larvae may reach the central nervous system and cause major tissue damage.

Baylisascaris procyonis is an intestinal roundworm endemic to the US raccoon population. Humans are infected by ingestion of worm eggs in raccoon feces. The median age for human infection is just over one year old, consistent with the propensity of young children to explore their environment orally (surprising that this behavior has not been naturally selected out of humans over the millenia!). I came across only one report of clinical recovery after infection (reference 2). Otherwise, cerebral Baylisascariasis results in either severe neurologic damage or death. That being said, subclinical infection has been suggested by a study in Chicago, which found 30 (8%) of 389 children 1–4 years of age were seropositive for B. procyonis, although none had experienced symptoms (reference 3).

The most common cause of eosinophilic meningitis in the United States is the presence of a ventriculoperitoneal shunt; but worldwide it is infection by Angiostrongylus cantonensis. In addition to Bayliscaris procyonis, other infectious causes of eosinophilic meningitis include Toxocara spp., Gnathostoma spinigerum, and neurocysticercosis (source: reference 2).

References:
1. Love S, et al, eds. Greenfield's Neuropathology, 8th edition. p. 1479.
2. Pai et al. Full recovery from Baylisascaris procyonis eosinophilic meningitis. Emerging Infectious Disease 13(6) p 928-30. June 2007
3. Brinkman WB, Kazacos KR, Gavin PJ, Binns HJ, Robichaud JD, O'Gorman M, et al. Seroprevalence of Baylisascaris procyonis (raccoon roundworm) in Chicago area children. In: Program and abstracts of the 2003 Annual Meeting of the Pediatric Academic Societies, Seattle, Washington; 2003 May 3–6. Abstract 1872. [cited 2007 Mar 29]. Available from http://www.abstracts2view.com/pasall/authorindex.php