Saturday, April 30, 2011

'Slug Nutty' Boxers, 'Head Scrambled' Football Players, and the Role of the Neuropathologist in Protecting the Public

American boxer John Heenan (1835-1873)
As part of National Lab Week activities, I delivered a presentation yesterday to staff at the College of American Pathologists headquarters in Northfield, IL on the topic of chronic brain injury among football players. Repetitive brain trauma in sport was first recognized among boxers, and thus the early-onset dementia -- and, in some cases, parkinsonian symptoms -- associated with this kind of trauma was named dementia pugilistica. Since the recognition of this phenomenon in other sports, most notably football, the entity has been renamed Chronic Traumatic Encephalopathy (CTE). Among the first papers describing repetitive traumatic brain injury in sport was one authored by neuropathologist Harrison S. Martland, MD, who published his results in the Journal of the American Medical Association in 1928 (Punch Drunk: JAMA 91:15, [1928] p. 1103-1107). Dr. Martland -- who worked in the pathology department of the City Hospital in  Newark, NJ and the office of the Chief Medical Examiner in Essex County, NJ -- wrote that "fighters in whom the early symptoms are well recognized are said by the fans to be 'cuckoo', 'goofy', 'cutting paper dolls', or 'slug nutty'." Dr. Marland concluded his report of 23 cases of dementia pugilistica with a call-to-arms to neurologists and neuropathologists:

"The condition condition can no longer be ignored by the medical profession or the public. It is the duty of our profession to establish the existence or non-existence of punch drunk by preparing accurate statistical data as to its incidence, careful neurologic examinations of fighters thought to be punch drunk, and careful histologic examinations of the brains of those who have died with symptoms simulating the parkinsonian syndrome. The late manifestations of punch drunk will be seen chiefly in the neurologic clinics and the asylums, and such material will practically fall to the neuropathologist connected with such institutions."

As was the case 100 years ago with boxing, chronic brain damage in "head scrambled" football players is now being widely acknowledged. It is the obligation of every blue-collar neuropathologist to advance our knowledge of CTE by recognizing it in our autopsy cases and supporting the work of the two white-collar neuropathologists most involved in bringing football-related CTE to public attention: Dr. Ann McKee of Boston Univeristy and Dr. Bennet Omalu of West Virginia University. With more than four million children and young adults playing football in this country, it is our moral obligation as neuropathologists and as citizens to become active participants in the public discussion surrounding this important social and public health issue.

Tuesday, April 19, 2011

Best Post of December 2010: Why the proliferation of neuropathology job openings?

The next in our "Best of the Month" series is from December 14, 2010. See the original post for comments as to why the job market appears to be so good for neuropathologists these days.

As I mentioned before on this blog, I am indebted to Sherry Miller, wife of neuropathologist Doug Miller, MD, PhD, for keeping me updated on neuropathology job openings. As a result, Neuropathology Blog has the most up-to-date and comprehensive listing of neuropathology job openings on the web. And there are a lot of jobs available! Sherry recently wrote me the following email regarding the current status of the neuropathology job market: "What do you think is going on?  A shortage? People leaving and moving around? Adding staff? (I don't think this is likely as most places are cutting staff.)  There are 28 jobs posted on the blog...now even if 6 are out of date because people haven't responded to the emails, that still leaves an incredible number of vacancies..... Maybe that would be a GOOD blog post? Ask what others think is going on?" I agree, Sherry. That WOULD be a good blog post. The floor is now open for comment...... 

Tuesday, April 12, 2011

Prehistoric Human Brain Found Pickled in Bog

A brain in near-perfect condition was found recently in the skull of a person who was decapitated over 2, 600 years ago. Here's the link to the article from Discovery News.

Thanks to Dr. Doug Shevlin for alerting me to this fascinating find.
Scientists believe submersion in anoxic environment preserved tissue.

Wednesday, April 6, 2011

CAP Neuropathology Education CD-ROM is now SAM-eligible!

For those of you who are scrambling to get neuropathology Self-Assessment Module (SAM) continuing medical education credits, the College of American Pathologists (CAP) now has an answer. If you attained your neuropathology board certification after 2006, every two years you must submit to the American Board of Pathology proof that you have obtained 20 SAM-eligible continuing medical education credits. If you subscribe to the CAP Neuropathology Education product, which provides you with two 5-credit SAM modules per year, you've got your requirement covered. This is a particularly attractive option since there are so few neuropathology SAM modules on the market. (For example, the American Association of Neuropathologists currently only offers a single 1-credit SAM module.) I just completed the first 2011 CAP Neuropathology CD-ROM installment. It is outstanding. Each edition features a theme, or  "minisymposium". The current edition's "minisymposium" focuses on tumor predisposition syndromes. (Pictured is a coronal brain section, taken from the current edition of the CD-ROM, of a brain with classic features of a classic tumor predisposition syndrome.) To just get CME credit, you only have to submit to the CAP answers to the questions posed on the CD-ROM itself. But if you want those crucial SAM-designated credits, you must additionally pass a 20-question online post-test.

The CD-ROM product is created by the CAP Neuropathology Committee, whose chair is Dr. Bette DeMasters. She recently informed me that the second 2011 CD-ROM edition will feature the first of a two-part discussion of vascular diseases of the CNS, with University of Florida's Dr. Tony Yachnis as author of the minisymposium introduction. For 2012, Dr. DeMasters tells me that the first edition will feature papillary tumors of the CNS, both primary and metastatic; and the second edition will feature the second part of the vascular disease discussion.

I've always been a big fan of the CAP Neuropathology CD-ROM product, but now it is more than just a quality product. It is now absolutely essential to the young neuropathologist who wants to stay on the good side of the American Board of Pathology.  Thank you, CAP!!!

Sunday, April 3, 2011

Best Post of November 2010: An Inquiry for Dr. Sandra Camelo-Piragua

The next in our "Best of the Month" series is from November 10. 2010:

I featured Dr. Sandra Camelo-Piragua this past June because of the interesting case she presented at the AANP diagnostic slide session. Dr. Camelo-Piragua has emerged from her neuropathology fellowship at Mass General and is a newly minted staff pathologist at the University of Michigan! Congratulations, Sandra! With her permission, I am reproducing an email I recently received from her. If you can help her in her quest, please write back to her directly or, better yet, post a comment. Thanks!



Dear Friends and Colleagues:

I am interested in buying a couple of muscle and nerve pathology books that are currently out of print in their editorial houses:

Pathology of Skeletal Muscle by Stirling Carpenter and George Karpati Oxford University Press, USA; 2 edition (January 15, 2001)
ISBN-10: 0195063643
ISBN-13: 978-0195063646

Atlas of Peripheral Nerve Pathology by R.H. M. King A Hodder Arnold Publication; 1st edition (July 15, 1999)
ISBN-10: 0340586664
ISBN-13: 978-0340586662

Please let me know if anybody is interested in selling a second hand copy that you are not currently using or if anybody knows where I can purchase them directly.

Thank you all for your help,

Sandra Camelo-Piragua, M.D.
Clinical Assistant Professor
University of Michigan
Pathology Department
Neuropathology Division
1301 Catherine Rd.
Medical Science Building I. Room M4213
Ann Arbor, MI 48109