Naegleria-tainted neti pots possibly killed two people

Naegleria fowleria (photo courtesy of Dr. Mark Cohen)

Now that it's winter and our noses and sinuses are being dried out by our heating systems, many of us turn to neti pots (also known as 'nose bidets'). The illustrious J. Clay Goodman, MD, neuropathologist at Baylor, just sent me an article from The Houston Chronicle warning people to use distilled, bottled, or boiled water. Officials in Louisiana are investigating whether a 51-year-old woman and a 20-year-old man both contracted the brain-eating amoeba Naegleria fowleri after using tap water in their neti pots. The disease, while rare, is most commonly contracted after inhaling water from a lake, pond or river. If investigators confirm the two victims died after using tap water from a neti pot it will be the first time the disease has been contracted from tap water.

Brigham and Women's Hospital Names Neuropathologist as New Chairman

Dr. Jeffrey A. Golden

In an obvious attempt to keep up with Massachusetts General Hospital, whose pathology chief is neuropathologist Dr. David Louis, Brigham and Women's Hospital in Boston has just announced that another neuropathologist, Dr. Jeffrey Golden, will become chair of pathology at that institution. Effective March 1, 2012, Dr. Golden will become the Ramzi S. Cotran Professor of Pathology at Harvard Medical School.  Brigham President Betsy Nabel, MD had this to say in a statement released today: Dr. Golden comes to BWH "from The Children's Hospital of Philadelphia, where since 2008, he has been serving as Pathologist-in-Chief in CHOP's Department of Pathology and Laboratory Medicine, cited as one of the leading pathology and developmental biology programs in the U.S. and one of the top NIH-funded research programs in Pathology.... Dr. Golden is recognized as an outstanding clinician, a highly skilled educator focused on training the next generation of physician/scientists in pathology and developmental biology, and a cutting-edge basic and translational research leader.  His studies in the multiple aspects of developmental biology and early nervous system development are key to gaining a greater insight into the pathogenesis of human diseases, including brain malformations, mental retardation, epilepsy and autism.  His efforts to date of establishing and elevating the bench to bedside and back to bench paradigm in the fast changing field of developmental biology and molecular diagnostics reflects a true commitment to quality and excellence in the application of new knowledge at the front lines of patient care."

As one neuropathologist commented to another: "Apparently neuropath is now ruling the world."

Improvements Recently Made to the AANP Website

The website for the American Association of Neuropathologists has recently undergone some improvements that might be of interest to NeuropathologyBlog readers:

-  The membership directory should be changed so it is searchable by location (hospital, city, or state), as well as by name.

- The Education Section provides useful links for those of us (myself included) who need to get our SAM credits in to the American Board of Pathology for maintenance of certification.

- A new tab has been added under the Professional Affairs heading, entitled “Survey". Results of recent AANP surveys are posted here.

-  A new heading for the left hand column on the home page has been added entitled “Links of interest". Several links pertinent to neuropathologists are listed. (Hey, where's NeuropathologyBlog?!?)


Thanks to AANP Vice-President Elect Liz Cochran, MD for providing me with this information.

Best Post of June 2011: A 58-year-old woman with headache and unsteadiness of gait

The next in our "Best of the Month" series is from June 14, 2011:

Here's a recent case of mine involving a lesion in the third ventricle of a 58-year-old woman who presented with headache and unsteadiness of gait. First, the imaging:

 

Axial CT

Sagittal T1 MRI

Axial T2 MRI

Coronal Gradient Echo

The neuroradiologist thought perhaps the lesion was a craniopharyngioma. But, the neurosurgeon was surprised that the lesion seemed to "pop out". Here's the specimen I received:

Outer Surface

Cut Surface

I smeared some of the viscous fluid from the cut surface onto a glass slide, cover-slipped it, and viewed it under polarized light:

Those cholesterol crystals certainly seem to suggest the possibility of craniopharyngioma. But, craniopharyngiomas do not have a smooth outer surface and do not just "pop out" into the neurosurgeon's hand. Here was my first glimpse of the histology the next day:

Cholesterol clefts and giant cells. Note in the upper picture that this xanthogranulomatous reaction appears to be continuous with the choroid plexus. Could this be a xanthogranuloma of the choroid plexus? I considered that, until I looked elsewhere on the slide and saw this:

This is the ciliated epithelium characteristic of a colloid cyst of the third ventricle, a tumor that can indeed "pop out" into the neurosurgeon's hand. Gross inspection did not reveal a cyst per se because the exuberant xanthogranulomatous reaction obliterated it. Cases like this have been described in the literature. For example, Dr. David Louis and colleagues wrote in a 1994 article entitled Third ventricle xanthogranulomas clinically and radiologically mimicking colloid cysts: Report of two cases (Journal of Neurosurgery. 81(4):605-9, 1994 Oct.) that "histopathologic examination revealed xanthogranulomas of the choroid plexus with only microscopic foci of colloid cyst-like structures." I would argue quite the opposite: that the xanthogranuloma derived from the colloid cyst and extended into the choroid plexus. Indeed, Dr. Peter Burger and colleagues write in the fourth edition of Surgical Pathology of the Nervous System and Its Coverings that "a xanthogranulomatous reaction occasionally supervenes in colloid cysts, largely replacing the epithelium in some cases."

Cool case.