A Jungian Approach to Individual Neuropathological Specimens

I was reading The Undiscovered Self (1958) by Carl Jung today, and noted that Jung's description of individual patients could also be applied to individual tumors:

"The statistical method shows the facts in the light of the ideal average but does not give us a picture of their empirical reality.... The distinctive thing about real facts, however, is their individuality.... There is and can be no self-knowledge based on theoretical assumptions, for the object of this knowledge is an individual - a relative exception and an irregular phenomenon. Hence, it is not the universal and the regular that characterize the individual, but rather the unique. He is not to be understood as a recurrent unit but as something unique and singular which in the last analysis can be neither known nor compared with anything else."

Consider this the next time you sign out a "bread and butter" glioblastoma!

Best Post of March 2015: The asinine reason why the name JCD was converted to CJD

The next in our "Best of the Month" series is from March 25, 2015.

Originally referred to as Jakob-Creutzfeldt disease (and believed by many to rightfully be called simply Jakob's disease), we now refer to this prion disease as Creutzfeldt-Jakob disease. Why? It all stems from a Dr. C. Joseph Gibbs, a colleague of D. Carleton Gajdusek's at the National Institutes of Health, who worked on this disease back in the 1960's. Here's the explanation, lifted from Nobel laureate Stanley Prusiner's Madness and Memory: The Discovery of Prions - A New Biological Principle of Disease:

"Alfons Jakob wrote a paper in 1921 describing several cases of progressive dementia with widespread neuronal loss in the brain. A year earlier, Hans Creutzfeldt had described the brain of a woman who died after a prolonged series of seizures. He found widespread vacuolation, but some medical scientists believe that his patient died of a seizure disorder complicated by hypoxic brain damage and doubt that she had what became known as CJD. So why did the named Jakob and Creutzfeldt become flipped in an important report on the disease, regarding the transmission to a chimpanzee? Twenty years passed before I found the answer, in conversation with Gibbs. 'When I was writing my first paper on the transmission of Jakob-Creutzfeldt disease to an ape,' he told me, 'I wanted to rename the disease Gibbs disease. I didn't think this would be acceptable to the scientific and medical communities, so I decided to reverse the names, because my first name is Clarence and my middle name is Joseph and my initials are C.J.' Thus did the diease become known as Creutzfeldt-Jakob disease, or CJD for short - a case of mind-boggling scientific mischief." 

Gibbs (left) and Gajdusek with a New Guinea kuru patient in 1972.

 
A remarkable case ofhubris, although from what I hear about Prusiner, he is not one to point fingers at those who grasp credit for the work of others.Gajdusek, also a Nobel prize winner, once wrote inhis diary the following about Prusiner:


""I never heard a word of original thought from you nor read such ideas in anything you authored for which I did not recognize immediately its source, which you always went out of your way to obscure. You a heretic? You a martyr? You a defender of unacceptable ideas? Bullshit! You shrewdly jumped onto a bandwagon of creative ideas and experimental work and shrewdly got on to the winning cart, proclaiming outrageously in press and media it was yours! I respect you less and less as your despicable game succeeds and you bask in your coveted fame."

But then again, Gajdusek himself, who died in 2008 at age 85, was no paragon of virtue.In the course of his research trips in the South Pacific to study kuru , Gajdusek had brought 56 mostly male children back to live with him in the United States, and provided them with the opportunity to receive high school and college education. He was later accused by one of these, now an adult man, of molesting him as a child. In fact, seven men testified in confidentiality about Gajdusek having had sex with them when they were boys.  Gajdusek was charged with child molestation in April 1996, based on incriminating entries in his personal diary and statements from a victim. He pleaded guilty in 1997 and, under a plea bargain, was sentenced to 12 months in jail. After his release in 1998, he was permitted to serve his five-year unsupervised probation in Europe. He never returned to the United States and ultimately died in Norway.

Best Post of November 2014: Robin Williams had Lewy Body Diesease

The next in our "Best of the month" series is from November 18, 2014:

Robin Williams

The official cause of Robin Williams' death, released Friday by the Marin County coroner, was ruled

Williams had long battled alcoholism, drug addiction and depression, but in November 2013 he was diagnosed with Parkinson's disease, according to his widow, after noticing a tremor in his left arm and difficulty moving on his left side as early as 2011.

Now a redacted pathology report from the autopsy on Williams' body has been made public and mentions "Diffuse Lewy body dementia,". Given that Dementia with Lewy Bodies can involve vivid visual hallucinations, it has now been speculated that perhaps such hallucinations may have lead to Williams' death.

Media reports, quoting anonymous "family sources," state that Williams' family believes that Lewy body disease was a critical "triggering" factor in his suicide. If so, this would be an unusual manifestation of the disease. Suicides have not been linked specifically to the hallucinations of Lewy Body Disease in the past.

Dennis Dickson, MD

"The use of the term dementia in the neuropathology report should not be inferred to mean that dementia was observed during life," warns Dennis Dickson of the Mayo Clinic in Jacksonville, who says he reviewed the neuropathology report.

"Mr. Williams was given a clinical diagnosis of (Parkinson's) and treated for motor symptoms. The report confirms he experienced depression, anxiety and paranoia, which may occur in either Parkinson's disease or dementia with Lewy bodies," Dickson said.

The asinine reason why the name JCD was converted to CJD

Originally referred to as Jakob-Creutzfeldt disease (and believed by many to rightfully be called simply Jakob's disease), we now refer to this prion disease as Creutzfeldt-Jakob disease. Why? It all stems from a Dr. C. Joseph Gibbs, a colleague of D. Carleton Gajdusek at the National Institutes of Health, who worked on this disease back in the 1960's. Here's the explanation, lifted from Nobel laureate Stanley Prusiner's Madness and Memory: The Discovery of Prions - A New Biological Principle of Disease:

"Alfons Jakob wrote a paper in 1921 describing several cases of progressive dementia with widespread neuronal loss in the brain. A year earlier, Hans Creutzfeldt had described the brain of a woman who died after a prolonged series of seizures. He found widespread vacuolation, but some medical scientists believe that his patient died of a seizure disorder complicated by hypoxic brain damage and doubt that she had what became known as CJD. So why did the named Jakob and Creutzfeldt become flipped in an important report on the disease, regarding the transmission to a chimpanzee? Twenty years passed before I found the answer, in conversation with Gibbs. 'When I was writing my first paper on the transmission of Jakob-Creutzfeldt disease to an ape,' he told me, 'I wanted to rename the disease Gibbs disease. I didn't think this would be acceptable to the scientific and medical communities, so I decided to reverse the names, because my first name is Clarence and my middle name is Joseph and my initials are C.J.' Thus did the diease become known as Creutzfeldt-Jakob disease, or CJD for short - a case of mind-boggling scientific mischief." 

Gibbs (left) and Gajdusek with a New Guinea kuru patient in 1972.

 
A remarkable case of hubris, although from what I hear about Prusiner, he is not one to point fingers at those who grasp credit for the work of others. Gajdusek, also a Nobel prize winner, once wrote in his diary the following about Prusiner:


""I never heard a word of original thought from you nor read such ideas in anything you authored for which I did not recognize immediately its source, which you always went out of your way to obscure. You a heretic? You a martyr? You a defender of unacceptable ideas? Bullshit! You shrewdly jumped onto a bandwagon of creative ideas and experimental work and shrewdly got on to the winning cart, proclaiming outrageously in press and media it was yours! I respect you less and less as your despicable game succeeds and you bask in your coveted fame."

But then again, Gajdusek himself, who died in 2008 at age 85, was no paragon of virtue.In the course of his research trips in the South Pacific to study kuru , Gajdusek had brought 56 mostly male children back to live with him in the United States, and provided them with the opportunity to receive high school and college education. He was later accused by one of these, now an adult man, of molesting him as a child. In fact, seven men testified in confidentiality about Gajdusek having had sex with them when they were boys.  Gajdusek was charged with child molestation in April 1996, based on incriminating entries in his personal diary and statements from a victim. He pleaded guilty in 1997 and, under a plea bargain, was sentenced to 12 months in jail. After his release in 1998, he was permitted to serve his five-year unsupervised probation in Europe. He never returned to the United States and ultimately died in Norway.

Robin Williams had Lewy Body Disease

Robin Williams

The official cause of Robin Williams' death, released Friday by the Marin County coroner, was ruled a suicide by hanging, with no evidence of alcohol or illegal drugs in his system and only therapeutic concentrations of prescribed medications.

Williams had long battled alcoholism, drug addiction and depression, but in November 2013 he was diagnosed with Parkinson's disease, according to his widow, after noticing a tremor in his left arm and difficulty moving on his left side as early as 2011.

Now a redacted pathology report from the autopsy on Williams' body has been made public and mentions "Diffuse Lewy body dementia,". Given that Dementia with Lewy Bodies can involve vivid visual hallucinations, it has now been speculated that perhaps such hallucinations may have lead to Williams' death.

Media reports, quoting anonymous "family sources," state that Williams' family believes that Lewy body disease was a critical "triggering" factor in his suicide. If so, this would be an unusual manifestation of the disease. Suicides have not been linked specifically to the hallucinations of Lewy Body Disease in the past.

Dennis Dickson, MD

"The use of the term dementia in the neuropathology report should not be inferred to mean that dementia was observed during life," warns Dennis Dickson of the Mayo Clinic in Jacksonville, who says he reviewed the neuropathology report.

"Mr. Williams was given a clinical diagnosis of (Parkinson's) and treated for motor symptoms. The report confirms he experienced depression, anxiety and paranoia, which may occur in either Parkinson's disease or dementia with Lewy bodies," Dickson said.

Fusiform gyrus key to understanding neuroanatomic basis of Capgras delusion

Thanks to Doug Shevlin, MD (pictured with crawdaddy) for steering me toward this TED talk by neuroscientist Vilayanura Ramachandran, MD, PhD. Dr. Ramachandran discusses the neuroanatomical substrate of the Capgras delusion, a neurological deficit about which I have blogged before. Dr. Ramachandran explains that the origin of this fascinating deficit stems from a severing (typically resulting from a stroke or neurodegenerative disorder) of the connection between the fusiform gyrus (the face perception area of the brain) and the amygdala (which gages the emotional significance of a perception). Good stuff....  including the crawdaddy.

Best Post of April 2010: Infamous Frontal Lobotomist was once President of the American Association of Neuropathologists

The next in our Best of the Month series is from April 28, 2010:

You may be surprised to learn that the infamous Walter J. Freeman,
MD (1895-1972), America's most prolific frontal lobotomist, was once president of the American Association of Neuropathologists. The AANP website lists Dr. Freeman (pictured) as having been president of the organization in 1946.

If you want to learn more about Dr. Freeman, get hold of a PBS documentary called The Lobotomist, which explores the background of the procedure popularization during the 1940’s through the ‘60’s. The neurologist Walter J. Freeman of Washington, DC was primarily responsible for the widespread performance of this surgery in the United States by developing the 10-minute, outpatient “ice pick lobotomy”. An ice pick-like instrument was inserted beneath the eyelid and over the eyeball of a patient who was rendered temporarily unconscious by electroshock. (The photo below from 1960 depicts the procedure performed on 12-year-old Howard Dully whose stepmother complained of the child's chronic misbehavior). When the instrument hit the thin orbital plate of the frontal bone, a few taps with a mallet would allow entrance into the intracranial cavity. The ice pick was then advanced upward, after which it was swept back and forth like a windshield wiper blade. The instrument was then extracted and the procedure was repeated on the opposite side. Approximately 30,000 of these procedures were performed before the medical establishment decided that it was ill-advised.

These procedures were designed to sever the connections of the brain with the prefrontal cortex. The goal was to leave patients with a degree of abulia, but with no focal deficits.  

Best Post of March 2010: A 'Rara Avis' has Flown Under My Microscope

The next in our Best of the Month series is from March 11, 2010:

I was recently sent a specimen from the cerebellum of a 27-year-old female patient who, during a routine funduscopic exam at her optometrist, was found to have papilledema and retinal hemorrhages. She was completely asymptomatic -- which of course suggests that we are dealing with a slowly progressive process. A head MRI was obtained:

An image-guided craniotomy ensued, yielding a cerebellar specimen. Photomicrographs of that specimen, at progressively higher magnification, follow:

The top picture exhibits normal cerebellar cytoarchitecture on the right giving way, on the left, to an internal granule cell layer that has transformed into larger gangliocytic neurons. The bottom picture demonstrates the cytologic appearance of these transformed ganglion cells.

This is an example of dysplastic cerebellar gangliocytoma, otherwise known as Lhermitte-Duclos disease (LDD). Dr. Peter Burger and colleagues, in their Surgical Pathology of the Nervous System and Its Coverings (4th edition, page 274), make this comment about LDD: "In the parlance of bird-watching, an endeavor with many similarities to surgical pathology, Lhermitte-Duclos disease is an entity not likely to be found on the 'life-list' of most pathologists." Well, this rara avis is now on my life-list!

When I came upon this tumor, I immediately thought of Dr. Ty Abel (pictured to the left), neuropathologist at Vanderbilt, who in 2005 authored an immunohistochemical study of 31 cases of Lhermitte Duclos disease. I emailed him this question: "What is the current thinking on LDD? Is it a hamartoma or a neoplasm or something in between?"

Ty's response: "Something in between may be the best answer. We suggested in our paper that it was a 'hypertrophic phenomenon superimposed upon a developmental malformation'. Our observations, as well as those in Suzie Baker's mouse model of this, suggest that aberrant signaling in the pathway disrupts granule cell migration as well as leading to their hypertrophy. Histologically, there is little proliferation, so the increase in tumor size over time may be due to cellular hypertrophy or to the abnormal myelinization of the molecular layer or both.Still, they do grow and sometimes come back after resection, making them tumor-like. Does your patient have evidence of Cowden's?"

No, my patient does not have other clinical evidence of Cowden syndrome. But Ty put me in touch with a leading authority on Cowden syndrome at the Cleveland Clinic, Dr. Charis Eng (pictured to the right) who emailed me this comment: "What we found in our initial series is that adult-onset LDD is almost always associated with germline PTEN mutations, i.e., has Cowden syndrome."

Whether or not this patient gets germline PTEN testing, she should be closely surveilled for breast, thyroid, and endometrial cancer, as there is a high incidence of these tumors in patients with Cowden syndrome.

And now a recut slide of this rare bird gets filed away in my teaching set, only to be let out of its cage again by the eager inquiry of a resident.

Best Post of January '10: Eight states still do not mandate reporting of CJD cases to public health authorities

The next in our series of "Best Posts of the Month" is from January 8, 2010:

Neuropathologists are obligated to keep generally up to date on Creutzfeldt-Jakob disease (CJD) research as they are called upon to perform autopsies on patients whose dementia may have been caused by a prion disease. The most overlooked players in the CJD research arena are patient advocates. Many patient advocates are fiercely motivated, often having been inspired to act by the CJD-related death of a loved one. One such advocate is Theresa Matthews (pictured on a 2006 lobbying visit to Washington with her teenage daughter Mary and Illinois Senator Durbin and then Senator Obama). Patient advocates often raise worthy questions about issues surrounding CJD research. One such question is whether adequate epidemiological data on CJD is being collected in every state. Ms. Matthews informs me that currently there are eight states that do not require physicians to report CJD cases. She testified about this issue at a June 2009 meeting of the FDA's Transmissible Spongiform Encephalopathies Advisory Committee. Here's an excerpt from her testimony:

"Accurate disease reporting is a basic and fundamental step of epidemiology... This cannot possibly be done if you are not even counting the cases. The current state of CJD epidemiology in this country is a joke and it is no laughing matter."

Strong words. But Ms. Matthews makes a good point. Mandated reporting is the first step in reliable epidemiological research. Every state should mandate reporting of CJD cases, whether discovered pre-mortem or only at autopsy. Here are the states that fail to mandate reporting: Washington, Nevada, New Mexico, Iowa, Indiana, Alabama, Kentucky, and West Virginia. If you are a resident of one of these states, contact your governor or state legislator to get this situation corrected!

Infamous Frontal Lobotomist was once President of the American Association of Neuropathologists

You may be surprised to learn that the infamous Walter J. Freeman,
MD (1895-1972), America's most prolific frontal lobotomist, was once president of the American Association of Neuropathologists. The AANP website lists Dr. Freeman (pictured) as having been president of the organization in 1946.

If you want to learn more about Dr. Freeman, get hold of a PBS documentary called The Lobotomist, which explores the background of the procedure popularization during the 1940’s through the ‘60’s. The neurologist Walter J. Freeman of Washington, DC was primarily responsible for the widespread performance of this surgery in the United States by developing the 10-minute, outpatient “ice pick lobotomy”. An ice pick-like instrument was inserted beneath the eyelid and over the eyeball of a patient who was rendered temporarily unconscious by electroshock. (The photo below from 1960 depicts the procedure performed on 12-year-old Howard Dully whose stepmother complained of the child's chronic misbehavior). When the instrument hit the thin orbital plate of the frontal bone, a few taps with a mallet would allow entrance into the intracranial cavity. The ice pick was then advanced upward, after which it was swept back and forth like a windshield wiper blade. The instrument was then extracted and the procedure was repeated on the opposite side. Approximately 30,000 of these procedures were performed before the medical establishment decided that it was ill-advised.

These procedures were designed to sever the connections of the brain with the prefrontal cortex. The goal was to leave patients with a degree of abulia, but with no focal deficits.

A Message from the President of the CAP Foundation regarding the Haiti Relief Effort

Dr. Jennifer Hunt ask me to publish the following open letter to pathologist colleagues regarding the College of American Pathologists Foundation Haiti Relief Effort. I urge readers to participate in this important initiative:

Dear Colleagues,

All of us are reading and watching the devastating news and seeing the wrenching pictures from Haiti in the aftermath of the terrible earthquake earlier this week. As a physician, I read the news and looked at the images with grief, with shock, and with a strong desire to reach out to the struggling people, injured and terrified. But, as a pathologist, I also realize that there is little I would be qualified to do in Haiti today, besides comfort those who are alive and have suffered loss and provide rudimentary first aid.

The CAP Foundation does have a way that you can help Haiti in this hour of need.

Our Humanitarian Grant program has sponsored several pathologists who have done wonderful laboratory outreach work in Haiti in the past. We are working with these pathologist-humanitarians to identify the areas where the CAP Foundation can help Haiti with short-term immediate support and the longer term struggles ahead. I urge you to join me in donating to the CAP Foundation, where pathologists will be part of providing laboratory services, humanitarian efforts, and medical aid during Haiti's moment of crisis and beyond.

I know that each and every one of you would go to Haiti, comfort the survivors, give medical care, and help laboratories cope with the medical situation. And, if you are a pathologist who is planning to join an established relief mission to Haiti, please contact the CAP Foundation and tell us your story. But, we are also acutely aware that there will be incredible needs, short and long term, that will require funding, supplies, and equipment, for health care and laboratory services. By donating to the CAP Foundation Haiti Relief Effort, pathologists can contribute what is needed most, when it is needed most, to provide these desperately needed services.

To help the CAP foundation provide support to the impoverished nation of Haiti, use this link and donate today.

Sincerely,

Jennifer Hunt, MD, MEd, FCAP
Interim President
CAP Foundation

Eight states still do not mandate reporting of CJD cases to public health authorities

Neuropathologists are obligated to keep generally up to date on Creutzfeldt-Jakob disease (CJD) research as they are called upon to perform autopsies on patients whose dementia may have been caused by a prion disease. The most overlooked players in the CJD research arena are patient advocates. Many patient advocates are fiercely motivated, often having been inspired to act by the CJD-related death of a loved one. One such advocate is Theresa Matthews (pictured on a 2006 lobbying visit to Washington with her teenage daughter Mary and Illinois Senator Durbin and then Senator Obama). Patient advocates often raise worthy questions about issues surrounding CJD research. One such question is whether adequate epidemiological data on CJD is being collected in every state. Ms. Matthews informs me that currently there are eight states that do not require physicians to report CJD cases. She testified about this issue at a June 2009 meeting of the FDA's Transmissible Spongiform Encephalopathies Advisory Committee. Here's an excerpt from her testimony:

"Accurate disease reporting is a basic and fundamental step of epidemiology... This cannot possibly be done if you are not even counting the cases. The current state of CJD epidemiology in this country is a joke and it is no laughing matter."

Strong words. But Ms. Matthews makes a good point. Mandated reporting is the first step in reliable epidemiological research. Every state should mandate reporting of CJD cases, whether discovered pre-mortem or only at autopsy. Here are the states that fail to mandate reporting: Washington, Nevada, New Mexico, Iowa, Indiana, Alabama, Kentucky, and West Virginia. If you are a resident of one of these states, contact your governor or state legislator to get this situation corrected!

Featured Neuropathology Fan: Cecilia Rohdin, DVM

It is not often that we neuropathologists find ourselves the subject of public admiration. We are, after all, an obscure lot. But Dr. Cecilia Rohdin (pictured), a Swedish veterinary neurologist, is a true fan. She writes:"I work at the University Animal Hospital in Uppsala, the only teaching hospital in Sweden for veterinary studies. I love animals and neurology and I would like to learn more neuropathology. Unfortunately veterinary neuropathology is not an area of great interest and excellence in Sweden. I would love the opportunity to be able to discuss unsolved mysteries and to learn more about the challenging but ever so fascinating world of neuropathology."
And now, a few questions for our featured fan:

Why are you interested in the neurology of cats and dogs?
"My interest in neurology started when I realized what a neglected field neurology was in veterinary medicine. I do believe that these patients deserve a diagnosis... Besides, neurology is extremely fascinating and it involves both medicine and surgery (at least in veterinary medicine where I am able to do both)."

What role can human neuropathologists play in the work that you do?
"A neuropathologist would be a dream come true for me!! I stuggle to find someone interested to make an effort to examine these patients properly and with enthusiasm. I know it is difficult for a general pathologist to interpret changes in the nervous system and I sometimes get very obscure and not always accurate pathology reports. I also want to be able to do reasearch and it is difficult to find someone (also abroad) to have the time and interest. I would like to know enough to not be so dependent on pathologists who are not really neuropathologists. I also want to learn to get a better general picture of my cases."

I see from your curriculum vitae that you are particularly interested in canine and feline motor neuron diseases. Do you want to hear from neuropathologists who share your research interests? If so, how should they contact you?
Yes! I can be reached via email at: cecilia.rohdin@live.se

Thanks for reading Neuropathology Blog, Dr. Rohdin. And thanks for the work you do in helping to relieve the suffering of our fellow mammals!

 

3

Dr. C. Everett Koop turns 93 today

Happy birthday, Dr. Koop! C. Everett Koop, MD turns 93 years old today. Surgeon General of the United States under President Reagan from 1982 t0 1989, Koop (pictured circa 1974) was probably the most influential figure to have ever filled that office. I met with Dr. Koop during his open office hours on April 19, 1995 at Dartmouth Medical School's Koop Institute. I found Dr. Koop to be a really nice guy -- definitely more gentle than his stern appearance initially suggests. Since I was applying to medical school at that time, Koop and I talked a bit about our respective experiences with the admissions process. Koop told me that he had been rejected from Columbia Medical School, an institution that he had looked forward to attending since his childhood in Brooklyn. He described the rejection as a "major blow". But Koop got the last laugh. Decades later, he told me, at an event honoring his accomplishments, Koop was introduced to the dean of the Columbia Medical School and said, "See, if you had only accepted me, I would have made something of myself."

Columnist Robert Novak dies at 78 from malignant brain tumor

Last summer I reported that Robert Novak (pictured), reknowned conservative columnist, was diagnosed with a brain tumor. The tumor was discovered after an investigation into why Novak struck a pedestrian while driving in Washington and then failed to remember that he had done so. The Chicago Sun-Times now reports that Novak passed away at 4:30 a.m. today. He had been hospitalized between July 10 and July 24. Novak’s malignant brain tumor, the specific histologic diagnosis of which has not been reported in the press, was discovered July 27, 2008. (Thanks to Dr. Doug "Scout" Shevlin for alerting me to this story.)

Neuropathologist talks about Jacko's brain in New York Post

Dr. John E. Donahue (pictured), neuropathologist at Brown University, is interviewed in a recent New York Post article regarding Michael Jackson's brain. Autopsy results on the brain have yet to be released. With all the press coverage about it, one wonders whether Jacko's brain will take on the same "treasured artefact" status held by Einstein's brain.

Michael Jackson's brain removed

According to a recent Associated Press report, singer Michael Jackson's brain was removed from his skull and is being held for further investigation. Brains at autopsy are often fixed in formalin for about two weeks to firm them up before cutting. According to the article, Los Angeles Assistant Chief Coroner Ed Winter said Jackson’s brain, or at least part of it, was still being held by investigators and would be returned to the family for interment once neuropathology tests were completed. Since Jackson died at UCLA medical center, I wonder if our friend and UCLA neuropathology chief Dr. Harry Vinters (pictured below) is performing the dissection in consultation with the coroner's office. Given the reported circumstances of Jackson's death, I would speculate that the autopsy findings not much more than some non-specific agonal cerebral edema.

William "The Refrigerator" Perry hospitalized in serious condition due to complications of Guillan-Barré syndrome

According to an associated press report, the gargantuan defensive tackle William "The Refrigerator" Perry (pictured below), who helped lead the Chicago Bears to a 1985 Super Bowl victory, has been hospitalized after complications related to Guillan-Barré syndrome (GBS).


Perry remains in serious condition at Aiken Regional Medical Center, located in his boyhood home of Aiken, South Carolina. Perry's nephew, Purnell Perry, said Tuesday that his uncle was admitted more than a week ago but was expected to recover. According to thebrainmatters.org, a website of the American Academy of Neurology Foundation, GBS "can be a devastating disorder because of its sudden and unexpected onset. Most people reach the stage of greatest weakness within the first 2 weeks after symptoms appear, and by the third week of the illness 90 percent of all patients are at their weakest. The recovery period may be as little as a few weeks or as long as a few years. About 30 percent of those with Guillain-Barré still have a residual weakness after 3 years. About 3 percent may suffer a relapse of muscle weakness and tingling sensations many years after the initial attack."

According to Perry's agent, Adam Plotkin of NOPAC Talent Agency, Perry's GBS had developed into a chronic form known as chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Depicted below is an electron photomicrograph of a transerve section of peripheral nerve involved with CIDP. Note the the thinly myelinated axons at the 3, 5, and 10 o'clock positions. Surrounding these axons are "onion-bulb" formations wherein multiple Schwann cells are concentrically arranged around inadequately myelinated axons.

Thanks to Mark B. Weiss of Earthwise Productions for alerting me to Perry's condition.

"What should exist?"

"What should exist?" Those are the words that guide the philanthropy of Microsoft Co-Founder Paul Allen's Institute for Brain Science. One thing that Mr. Allen believes should exist is a genetic map of the murine brain, and he put up the $100 million to get that done. The searchable digital atlas of gene expression presents a comprehensive online platform for exploration of the brain at the cellular and molecular level. It is available on-line, for free, to anyone who wants to know which of the 21,000 genes in the mouse genome is activated in a particular area of the mouse brain. Pictured is a sample photomicrograph demonstrating the expression of a type of GABA receptor via in situ hybridization in one sagittal brain slice. In recognition of this and his other initiatives on behalf of brain science, Mr. Allen is being awarded the 2009 Public Leadership in Neurology Award by the American Academy of Neurology.

On this day in 1984: Marvin Gay killed (indirectly) by a brain tumor

Twenty-five years ago today, one day before his 45th birthday, legendary singer and songwriter Marvin Gaye was fatally shot by his father when the younger Gaye attempted to intervene during an argument between his parents purportedly over misplaced business documents. Marvin Sr. used a gun that Marvin Jr. had given his father only four months earlier. Marvin Sr. was sentenced to six years probation after pleading guilty to manslaughter. Charges of first-degree murder were dropped after doctors discovered Marvin Sr. had a brain tumor which may have impaired the elder Gaye's judgement. Thanks to Dr. Doug Shevlin of Springfield, IL for alerting me to this connection between Marvin Gaye's death and neuro-oncologic disease.