I discuss issues pertaining to the practice of neuropathology -- including nervous system tumors, neuroanatomy, neurodegenerative disease, muscle and nerve disorders, ophthalmologic pathology, neuro trivia, neuropathology gossip, job listings and anything else that might be of interest to a blue-collar neuropathologist.
Monday, December 31, 2007
Doug Miller moves to Missouri
Dr. Douglas C. Miller, former neuropathologist at NYU, has recently moved to the University of Missouri at Columbia. Good luck in Mizzou, Doug!
Thursday, December 27, 2007
Medial lemniscus
Brain cutting sessions with residents can get repetitive after a while unless you have new neuroanatomy information to share with them every so often. To that end, here's a nice description of the course of the medial lemniscus as it ascends through the brainstem written with a visual metaphor that will really stick in your mind. You can use this metaphor in describing the medial lemniscus during your next brain cutting session. The source is my favorite basic neuropathology book: "Practical Review of Neuropathology" by Fuller and Goodman. From page 113:
"The ascending proprioceptive and fine touch system has its relay nuclei, the nucleus gracilus for lower extremity and trunk, and the nucleus cuneatus for upper extremity, neck, and upper trunk...at the cervicomedullary junction. The second order neurons from these nuclei decussate to form the medial lemniscus that ascends through the brainstem to eventually innervate the ventral posterior lateral (VPL) nuclues of the thalamus. In the medulla, the medial lemniscus is arranged as a vertical (ventral to dorsal ) strip of fibers in the midline with the upper extremity fibers being most dorsal and the lower extremetiy fibers being most ventral; i.e., the sensory homunculus in the medulla is 'standing straight up'. The medial lemniscus rotates to the horizontal in the pons and by the time it reaches the midbrain has rotated further so that the fibers from the lower extremity are now more dorsal than those of the upper extremity. Imagine a reveler on Bourbon Street in New Orleans. Early in the evening, the individual is standing vertically against a lamppost enjoying the libations and this is analogous to the position of the medial lemniscus in the medulla. By mid-evening, the partygoer slides down the lamppost and lays on the street analogous to the increasingly horizonatal disposition of the medial lemniscus in the pons. Finally, the besotted reveler is pulled from the street by his ankles by the local constabulary analogous to the 'feet up' orientation of the medial lemniscus in the midbrain."
I should note that I had to correct a few typos in this as I transcribed it. For example, the authors write "Bourdon Street" instead of "Bourbon Street" in New Orleans. And they refer to the "nucleu gracilus" instead of the "nucleus gracilus". That being said, I still think that Fuller and Goodman provide a wonderful analogy that really helps in explaining the anatomy of the medial lemniscus!
"The ascending proprioceptive and fine touch system has its relay nuclei, the nucleus gracilus for lower extremity and trunk, and the nucleus cuneatus for upper extremity, neck, and upper trunk...at the cervicomedullary junction. The second order neurons from these nuclei decussate to form the medial lemniscus that ascends through the brainstem to eventually innervate the ventral posterior lateral (VPL) nuclues of the thalamus. In the medulla, the medial lemniscus is arranged as a vertical (ventral to dorsal ) strip of fibers in the midline with the upper extremity fibers being most dorsal and the lower extremetiy fibers being most ventral; i.e., the sensory homunculus in the medulla is 'standing straight up'. The medial lemniscus rotates to the horizontal in the pons and by the time it reaches the midbrain has rotated further so that the fibers from the lower extremity are now more dorsal than those of the upper extremity. Imagine a reveler on Bourbon Street in New Orleans. Early in the evening, the individual is standing vertically against a lamppost enjoying the libations and this is analogous to the position of the medial lemniscus in the medulla. By mid-evening, the partygoer slides down the lamppost and lays on the street analogous to the increasingly horizonatal disposition of the medial lemniscus in the pons. Finally, the besotted reveler is pulled from the street by his ankles by the local constabulary analogous to the 'feet up' orientation of the medial lemniscus in the midbrain."
I should note that I had to correct a few typos in this as I transcribed it. For example, the authors write "Bourdon Street" instead of "Bourbon Street" in New Orleans. And they refer to the "nucleu gracilus" instead of the "nucleus gracilus". That being said, I still think that Fuller and Goodman provide a wonderful analogy that really helps in explaining the anatomy of the medial lemniscus!
Thursday, December 13, 2007
Neuropathology Course on the Web
Dr. Dimitri P. Agamanolis of Akron Children's Hospital has a neuropathology website that essentially provides a primer on the basics of neuropathology. Check it out at:
http://www.neuropathologyweb.org/
I'll be away on vacation until after Christmas, so there will be no new posts until that time. Merry Christmas!
http://www.neuropathologyweb.org/
I'll be away on vacation until after Christmas, so there will be no new posts until that time. Merry Christmas!
Tuesday, December 11, 2007
Upcoming American Academy of Neurology Annual Meetings
For those of you who like to plan ahead, the 2008 AAN annual meeting will be in Chicago. The 2009 AAN meeting will be in Seattle, Washington. The 2010 Annual Meeting will be in Toronto, Ontario, Canada. There's a link to the AAN website below.
Monday, December 10, 2007
Dr. Asao Hirano
For those wondering who the older gentleman is in the picture with me below, it is none other than the esteemed Dr. Asao Hirano, after whom the actin-associated intraneuronal inclusions known as Hirano bodies are named. He is currently on faculty at Albert Einstein College of Medicine in New York City.
Friday, December 7, 2007
Answer to Quiz Question
Joseph Merrick was originally thought to be suffering from neurofibromatosis type I, a genetic disorder also known as von Recklinghausen's disease. However, it was postulated in 1986 that Merrick actually suffered from Proteus syndrome (a condition which had been identified by Michael Cohen seven years earlier). Unlike neurofibromatosis, Proteus syndrome (named for the shape-shifting god Proteus) affects tissue other than nerves, and is a sporadic rather than familially transmitted disorder. In July 2003, Dr. Charis Eng announced that as a result of DNA tests on samples of Merrick's hair and bone, she had determined that Merrick certainly suffered Proteus syndrome, and may have had neurofibromatosis type I as well. (The above information is adapted from the wikipedia article. But I can vouch for its authenticity.)
The clinical manifestations of Proteus syndrome are, as the name implies, protean. They include:
- Partial gigantism of hands or feet
- Hemihypertrophy
- Subcutaneous lipomas
- Multiple nevi
- Areas of thickened skin and subcutaneous tissue
- Macrocephaly
- Skull anomalies
- Accelerated growth in long bones
- Mentation can be normal or retarded
The clinical manifestations of Proteus syndrome are, as the name implies, protean. They include:
- Partial gigantism of hands or feet
- Hemihypertrophy
- Subcutaneous lipomas
- Multiple nevi
- Areas of thickened skin and subcutaneous tissue
- Macrocephaly
- Skull anomalies
- Accelerated growth in long bones
- Mentation can be normal or retarded
Thursday, December 6, 2007
Quiz Question
From which of the phakomatoses did Joseph Merrick (played by John Hurt in the movie 'Elephant Man') suffer? The answer will appear in tomorrow's posting.
Wednesday, December 5, 2007
Pediatric Neuro-Onc Meeting this summer
For those looking for a meeting to attend, the International Symposium on Pediatric Neuro-Oncology (ISPNO 2008) wil take place June 30 – July 2, 2008 in Chicago. The abstract submission deadline is January 15th. Here's the link for more info:
http://www.ispno.com/page/page/4477724.htm
http://www.ispno.com/page/page/4477724.htm
Monday, December 3, 2007
14-3-3 protein
A clinician at my hospital ordered a CSF 14-3-3 protein on a lethargic elderly woman with a urinary tract infection. What a waste! The problem with clinicians ordering this test unnecessarily is that it obligates the lab technicians to decontaminate equipment to protect against the possibility of prion contamination. It's an inefficient use of resources for a test that is very non-specific. The patient in question had none of the characteristic clincal signs, nor did she have an EEG done to gathter evidence that she may have CJD. Ordering that test in this patient is just bad medicine.
Subscribe to:
Posts (Atom)
Neuropathology Blog is Signing Off
Neuropathology Blog has run its course. It's been a fantastic experience authoring this blog over many years. The blog has been a source...
-
Shannon Curran, MS with her dissection Shannon Curran, a graduate student in the Modern Human Anatomy Program at the University of Co...
-
Last summer I put up a post about a remarkable whole nervous system dissection that was carried out at the University of Colorado School of ...