AANP's "Special Course" is Underway

I am currently in attendance at the American Association of Neuropathologists Annual Meeting special course entitled Acquired Neuropathology in a Changing World. A crowd of more than 300 attendees are present. Dr. Leroy Sharer recently finished his presentation, entitled "AIDS Neuropathology - A 30 Year Perspective", which provided a unique insight into the evolution of our understanding of HIV in the CNS.

Dr. Sharer sharing his persepctive on AIDS neuropathology this morning

Meanwhile, the accomodations at The Palmer House Hotel here in Chicago are magnificent.

Detail from ceiling of the lobby at Chicago's landmark Palmer House Hotel

Yasser Lopez: A Modern-Day Phineas Gage

Above is an x-ray released yesterday by Jackson Memorial Hospital in Miami, Florida depicting a spear entering the head, traveling through the brain, and piercing the opposite skull surface of 16-year-old Yasser Lopez. The boy is on the road to recovery after being accidentally shot in the head while loading a speargun with a friend earlier this month

"It was about one inch above his right eye straight through," said trauma surgeon Dr. George Garcia. "You could feel the tip under the skin on the posterior part of the skull."

"The most important thing is to resist that temptation to pull the thing out," neurosurgeon Dr. Ross Bullock said. Bullock and his trauma neurosurgeon team determined the tip of the spear inside Lopez's head was actually a screw tip. "It was possible for us to figure out a strategy during the operation to be able to unscrew the tip of the spear, instead of having to get this whole spear dragged out through his brain," Bullock said.

Bullock said Lopez can speak normally. "He can, for example, he says he's not having pain. He's worried about the fact he can't use his left-side properly."

Lopez's story brings to mind that of Phineas P. Gage, whose left frontal lobe was obliterated by a railroad spike that exploded upward when he was tamping it down in 1848.

Phineas P. Gage (1823-1860)

As for the day he got shot, Lopez knows nothing. Doctors expect him to make a near-full recovery.

Read more here: http://www.miamiherald.com/2012/06/18/2856543/doctors-miami-dade-teen-shot.html#storylink=cpy

Best Post of January 2012: The area postrema is not the only area where the BBB is lacking

The next in our "Best of the Month" series comes from January 9, 2012:

I'll paraphrase a question posed by one of my 2nd-year students at Southern Illinois University School of Medicine:

I understand that the Area Postrema was a site where there was increased penetrability of the blood brain barrier. I am not sure, but thought I had come across additional sites of increased penetrability last year in my reading. Are there other sites where there is increased permeability of the BBB?

 

In pondering an answer to this question, I immediately thought of the illustrious Dr. John Donahue, consummate neurologist, neuropathologist, and neuroanatomist.  I posed the question to him and got the following response:

Dr. John Donahue, Brown University, Providence, RI

"Not increased permability of the BBB.  NO BBB!  Area postrema is one of the circumventricular organs, areas in the brain that lack a BBB.  Being the vomiting center, it is imperative that it lacks a BBB so that it can sample the systemic circulation.  Being in the medulla, it is the only circumventricular organ that is adjacent to the fourth ventricle; all of the others are adjacent to the third.  It is the only paired circumventricular organ; all of the others are single and midline.  The other circumventricular organs are subfornical organ, organum vasculosum of the lamina terminalis, median eminence, posterior pituitary gland, subcommissural organ, and pineal gland."

 

There you have it!

2,000 players unite in suing NFL over head injuries

CNN reports today that a unified lawsuit on behalf of more than 2,000 National Football League players has been filed against the league in federal court, alleging that the NFL failed to acknowledge and address neurological risks associated with the sport and then deliberately failed to tell players about the risks they faced. The complaint unites the more than 80 pending lawsuits filed against the NFL.

Lawyers representing the players cited "dementia, depression, reduced cognitive ability, sleeplessness, early-onset Alzheimer's, and a debilitating and latent disease known as chronic traumatic encephalopathy" as some of the specific injuries caused by head trauma in the NFL.

Thanks to Dr. Jeff Bennett for alerting me to this story.

Best Post of December 2011: Naegleria-tainted neti pots possibly killed two people

Naegleria fowleria (photo courtesy of Dr. Mark Cohen)

The next in our Best of the Month series is from December 16, 2011:
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.

Update on May 29, 2012: A comment was left in the original post suggesting that the water used in the two deaths may have resulted from the use of well water, not tap water. I was unable to confirm that contention in an internet search on the topic. All the news sources I consulted state that the water was indeed tap water.

National Baseball Park Tour Raises Awareness of PSP

The Shea's at AT&T Park in San Francisco

CurePSP is an organization dedicated to raising public awareness of progressive supranuclear palsy (PSP). A member of the board of CurePSP, Justin Shea, is currently taking his parents on a tour of baseball parks throughout the nation in an effort to raise public awareness and funds for PSP. Justin, whose father was diagnosed with PSP in March of 2009, is documenting the family's journey with a blog. Justin writes: "[S]ince my Dad's diagnosis, we have been able to raise both awareness and considerable funds to help researchers find a cure... Collectively, we have raised over $30,000. We have decided to continue these efforts throughout the country by visiting every MLB park."

A Mild Case of Neurocystircercosis

From Andrew Sullivan via Dr. Doug Shevlin.

New Study Looks at Head Impacts in Youth Football

We neuropathologists, and society as a whole, has spent a lot of time over the last couple of years rethinking the long-term effects brain damage causes by repeated concussive and subconcussive blows to the heads of professional and college football players. But what about the 3.5 million kids in American who play below the high school level? Dr. Peter Cummings today sent me a link to a report regarding groundbreaking research being done at Virginia Tech in which impact-measurement instruments were placed on 7 and 8-year-old football players. Data was collected on more than 750 hits to the head over the course of the season.

Lead researcher, Stefan Duma, a professor of Biomedical Engineering, reports that some head impacts in youth football are equal in force to some of the bigger hits he sees at the college level.  The average kid received 107 head impacts during the course of the season. This is few than seen in high school (which averages about 500 per season) and college (which amounts to about 1000 per season.). But what about the magnitude of these hits? The median impact was 15 g's. In Duma's study, there were 38 impacts that were 40 g or greater (almost all of which occurred during practice.) Six impacts were over 80 g's, which starts to get into the range of risk for concussion. “Nobody expected to see hits of this magnitude,” says Duma, who speculates that once players start seeing hits of 30 g's above, there is a risk for cumulative injury.

Here's the video report from reporter Stone Philips. The interviews with the parents of these youth players perplexed me. All of the parents featured found the results concerning, but none expressed any thoughts about having their child switch to another sport.

"This is the single biggest change in education since the printing press."

Anant Agarwal, President, edX

On rare occasion, I stray from this blog's focus on clinical neuropathology to inform readers about new innovations in education. After all, we neuropathologists, almost by definition, are educators. I would therefore like to introduce a new direction in higher education that may indeed change the world. I am talking about edX, a joint venture between Harvard and MIT that will offer online learning to millions of people around the world for free. Anyone with an internet connection, whether you are a shopkeeper in Bangalore or a teenager in Modesto, will soon be able to take graded courses at MIT and Harvard while engaging with other online students and interacting with professors. MIT launched the prototype for this new innovation this spring with a course called "Circuits and Electronics". About 120,000 individuals worldwide registered for this single course -- a number approaching the total number of living MIT alumni! Anant Agarwal, MIT’s Director of the Computer Science and Artificial Intelligence Laboratory and new President of edX, had this to say about this new venture: “Online education for students around the world will be the next big thing in education. This is the single biggest change in education since the printing press.”

At this point, no degrees will be granted, but students will receive certificates verifying completion of a course.

At the press conference announcing the launch of edX, Harvard Provost Alan Garber said:  “We believe in not only producing educational courses online, but using this as literally an unprecedented opportunity to examine fundamental questions about how we learn. This is not only about how to design the best online courses. This is about learning how to use the classroom more effectively… It’s enabling us to ask very different questions than we’ve typically asked before. For example, we need not only ask how will our students do on an exam, we can begin to ask questions about how well they acquire and apply the information months after the course has ended… This is a platform that will enable us to do research that simply hasn’t been possible before.”

There no doubt that this new endeavor will change the face of education, democratizing and radically diffusing knowledge and intellectual discourse. EdX is the beginning of a new way of teaching and a new way of learning, and the change will extend to medical education, including neuropathology education. This should be interesting.....

Best Post of November, 2011: Neuropathology Focus of New SNO President's Address

The next in our "Best Post of the Month" series is from November 18, 2011:

Over 1400 attendees at 2011 SNO meeting in Anaheim

                   Dr. Aldape discussed brain tumor biomarkers                

Same view as above, at 40X

Neuropathology took center stage at the Society for Neuro-Oncology (SNO) meeting today as Dr. Kenneth D. Aldape, neuropathogist at the University of Texas MD Anderson Cancer, was introduced as the next president of the society. Dr. Aldape also delivered an address to more than 1400 attendees about the future of surgical neuropathological reporting. Aldape's research centers on the clinical utility of brain tumor biomarkers as prognostic indicators. He described how the use of biomarkers will change the way surgical neuropathology diagnoses are rendered. He noted that the broad morphologic spectrum one sees in gliomas makes the recommendations of the World Health Organization sometimes difficult to implement. For example, the difference between a WHO grade II and grade III astrocytoma is based principally on whether or not mitotic figures are "brisk" as interpreted by the examining neuropathologist. Yet, the imprecision of that approach is obvious when one considers variables such as the diligence of the neuropathologist in identifying mitotic figures, the often equivocal morphology of apoptotic-versus-mitotic cells, as well as the variable technical quality of tissue processing and staining. The use of biomarkers will make diagnoses more reliable and will provide more useful prognostic information to the oncologist. Dr. Aldape projected onto the screen an example of a recent surgical pathology report he had generated at MD Anderson. The report highlighted the status of the several biomarkers, including G-CIMP, IDH1, pHH3, MIB1, 1p/19q deletion, and MGMT. Then, only in the last sentence of the comment, was it noted that the histology and biomarker profile was most consistent with a WHO grade III (anaplastic) astrocytoma. It was as if the WHO diagnosis and grade were a perfunctory afterthought. Finally, Aldape noted that biomarkers will become even more important in the coming years as biomarker data becomes "actionable", allowing the oncologist to personalize the treatment of a particular tumor depending on the biomarker profile. These are exciting times....

Photomicrographs of last month's spinocerebellar ataxia type 6 case

A month ago, I posted gross photographs from an autopsy case of mine of a patient with spinocerebellar ataxia type 6. I am now following up with histologic images for this case. The most striking feature was the marked loss of Purkinje cells, which makes sense because SCA6 involves mutation of a calcium channel that is highly expressed on Purkinje neurons:

Many remaining Purkinje neurons demonstrated degenerative changes, including mis-shapened nuclei

Attenuated cerebellar granule cell layer

More Purkinje cells in bad shape

Cerebellar dentate neurons also dengenerated, but not as extensively as Purkinje cells

Mild involvement of inferior olives. Note the mis-shapen and darkened nuclei of neurons in this location.

Pons minimally effected, with only occasional degenerating neurons as seen in the center of this photomicrograph next to a normal neuron