Doctor Creates Centralized Pathology Web Resource

Bertalan Mesko, MD (pictured) has created a nice collection of pathology web resources called PeRSSonalized Pathology, which features the best medical journals, news sites, blogs and tweeters dedicated to pathology. Needless to say, Neuropathology Blog is included! "If you have any suggestions," says Dr. Mesko, "feel free to send those to me so I can improve the resource." Dr. Mesko can be emailed at info@webcina.com.

Best Post of August '09: New Edition of Robbins and Cotran Pathologic Basis of Disease released

The next in our series of "Best Posts of the Month" is from August 2, 2009:

A new edition of the canonical Robbins and Cotran Pathologic Basis of Disease appeared recently and is no doubt being widely purchased by second-year medical students throughout the country as they begin the academic year later this month. I emailed the authors of the neuropathology-related chapters and asked them what was new and improved about the 8th edition. First, Douglas C. Anthony, MD, PhD of the University of Missouri Pathology Department (pictured below), who co-authored the chapters on the peripheral and central nervous systems with Drs. Matthew Frosch and Umberto DiGirolomi, had the following to say about the the new edition:

"The neuro chapters were quite an undertaking, trying to incorporate all the progress in neurosciences without making the new edition so big that it's unattractive to medical students. We tried very hard to keep it near the same size, and use more illustrations to keep it concise. One thing that we did throughout the 8th edition is to reduce the discussions of normal histology (only placing some of it where it's necessary to understand the pathology). So normal nerve, muscle, and brain are all removed. That allowed us to introduce more on advances in molecular understanding of all the pathologic processes. We have done that throughout, but in some places removed the text to create [tables] or figures. For example, hereditary sensory and autonomic neuropathies are expanded as a table, and the hereditary motor and sensory neuropathies as a figure with the myelin layers. For the limb-girdle muscular dystrophies, we listed all that were known at the time of press, and included others as separate hereditary myopathies. We included congophilic angiopathy with hemorrhages, and included a CADASIL figure, and expanded molecular classifications where they are pertinent to management, such as MGMT in glioblastomas and chromosome 1/19 in oligos. Where there was just too much to include in an introductory pathology text, we referenced more detailed papers or major texts, to send the interested student to those."

Next, I contacted Robert Folberg, MD (pictured below), ophthalmic pathologist and dean of the Oakland University William Beaumont School of Medicine in Michigan, for his take on the chapter he authored on the eye. His statement follows:

"The major revision [in the eye chapter] was the jump between the 6th and 7th edition. The chapter was revised completely during the 6-7 edition transition. The current chapter is a bit shorter - as are most chapters in the book - and the references and some concepts have been updated. There are no 'earth-shattering' changes between [the 7th and 8th editions]."

There you have it. I am sure I can speak for all of the readers of this new edition, both students and faculty alike, in expressing my appreciation for the countless hours of work that went into creating this text. I look forward to diving into it as the new academic year begins!

NFL to encourage players to donate brains for study

Fox Sports reports on this new development. Brains would go to Boston University.

Doug Miller's Modern Surgical Neuropathology: "a rarity in medical publishing in the 21st century"

Modern Surgical Neuropathology by Dr. Doug Miller (pictured) was reviewed by Dr. Leroy Sharer in last month's Journal of Neuropathology and Experimental Neurology. (I published a post on this book in June of this year.) Dr. Sharer points out that Dr. Miller's book is extraordinary in that it is penned by a single author -- "a rarity in medical publishing in the 21st century", writes Sharer. Some may take issue with Dr. Miller's fiercely independent perspective on surgical neuropathology, but one must respect his courage to say what he thinks. He is not afraid to challenge mainstream concepts. For instance, in his review, Dr. Sharer notes that Dr. Miller "devised his own tumor grading and classification schema, which he relates to others in use, particularly the World Health Organization system from 2007". If more neuropathologists had the chutzpah to put their perspectives out in the public arena for debate, it would undoubtedly invigorate the field!

A Snapshot of the people behind the brains we autopsy

A Rhode Island patient with frontotemporal dementia.

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!

 

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The NFL to deal with concussion more aggressively: a good step, but not enough

The recent hullaballoo, which included my own blog post on the subject, regarding the long-term consequences of football-related traumatic brain injury has moved the National Football League to take measures to more aggressively manage players who suffer concussions. The New York Times reported yesterday that players who exhibit any significant sign of concussion will be removed from a game or practice and be barred from returning the same day. The new rules will take effect in this week's games. I salute the forthright manner in which the NFL is dealing with new concerns regarding the brain injuries that are intrinsic to the game. I would advocate more dramatic rules changes, such as requiring that linemen start each play in an upright position rather than in the traditional three point stance exemplified in the now-defunct New England Patriots logo pictured. Regardless of what changes are made at the professional or school-boy level, I still intend to prohibit my own son from ever playing the sport of football. As Dr. Joseph Maroon, the team neurosurgeon for the Steelers and a member of the N.F.L.’s committee on concussions said: "On every play there are traumatic experiences to the head."  The football season is short, and life is long. Thanks to Drs. Doug Shevlin and Mike Beckmann for making me aware of these emerging developments.

Marathon brain cutting session at UCSD streamed live today

The Brain Observatory at the University of California San Diego is today beginning a 30-hour brain cutting session with a live online stream of the procedure wherein the brain of H.M., an amnestic patient, is being thinly sliced from front to back into whole-mount frozen histologic sections. Each brain slice will be approximately 70 microns thick, about the thickness of a human hair. An average-sized brain produces 2,600 to 3,000 such slices. The UCSD Brain Observatory, headed by Dr. Jacopo Annese, is dedicated to the study of the architecture of the human brain using multiple complementary imaging modalities, including autopsy. Thanks to Thomasina Bailey for alerting me to this extraordinary brain cutting event!

Best Post of July '09: Behold! Phineas Gage revealed!

The next in our series of "Best Posts of the Month" is from July 30, 2009:

The Los Angeles Times reports that a daguerreotype depicting Phineas Gage has been discovered. In the next issue of the Journal of the History of the Neurosciences, an article establishing the identity of the man holding an iron rod (see photo above) is that of Mr. Gage. This is the only known photograph of perhaps the most legendary neurology patient in history. To illustrate the executive function orchestrated by the prefrontal lobes, medical students throughout the country are told the story of the railroad construction foreman Phineas Gage, who, in 1848, suffered an accident on the job which resulted in a 13-pound iron rod shooting through the front of his brain. Gage survived the accident, and lived 11 years more. But he was never the same, exhibiting "frontal release" signs characterized by disinhibition and impulsivity.

The photograph was discovered by Jack and Beverly Wilgus, a couple from Massachusetts who owned the photograph for 30 years, thinking it depicted a whaler holding a harpoon. When they posted the picture online, an anonymous tipster suggested it might be Gage. The LA Times article continues the story: "Intrigued, the Wilguses compared their image to that of a life mask at Harvard Medical School's Warren Anatomical Museum and found it could be superimposed perfectly, with scars lining up correctly. Apparent writing on the metal rod in the image matches writing on Gage's iron rod, which is also in the Warren Museum."

Finally, a simple cartoon depicting the anatomic location of the transentorhinal cortex

In our teaching and in our autopsy reports, we neuropathologists often make reference to the transentorhinal cortex as it is -- in the Braak and Braak staging system -- the region where the earliest Alzheimer pathology appears. I have found it difficult to find a clear illustration of the anatomic location of the transentorhinal cortex in texts or on the internet. However, I came across a nice cartoon of the divisions of the parahippocampal gyrus, including the transentorhinal cortex, in an online presentation by Prof. Jillian Kril of the Pathology Department at the University of Sydney, NSW. Prof. Kril kindly emailed me a copy of the illustration, which is depicted above with the addition of a label for the presubiculum.  Feel free to use this cartoon for teaching purposes with the following credit: Adapted from Harding AJ, Halliday GM, Kril JJ. Variation in hippocampal neuron number with age and brain volume. Cerebral Cortex (December, 1998) 8:710-718.

Neuropathology Blog Initiates Job Listing Feature

I am today initiating an open position list on Neuropathology Blog. In the column to the right, I will be adding neuropathology positions as I become aware of them. I have inaugurated the process by listing three open positions, along with contact information. First, Rush University Medical Center is looking for a neuropathologist to replace the illustrious Dr. Liz Cochran, who has moved to the Medical College of Wisconsin. Secondly, the esteemed Dr. Mark Cohen is looking for a neuropathology colleague at Case Western Reserve University. Finally, Genentech in South San Francisco, CA is looking for a neuropathologist. If you hear of other positions that are available, please write in so that I can add to the list. Good luck to the job seekers. And thanks to Dr. Peter Cummings for suggesting this feature!

Epidermal nerve fiber density assessment: probably not worth doing in-house

About a month ago, I addressed the issue of skin biopsies for patients with peripheral neuropathy to assess for nerve fiber density. Since that post, I have heard that this test is not something to be taken lightly. Dr. Tom Smith (pictured) of the University of Massachusetts had this to say about the test: "Basically, to assess fiber density correctly in these skin biopsies, you need a considerable investment in technology (e.g. a confocal microscope, morphometric software program, etc) and technician training -- do you really have time to sit and count fibers?" Dr. Smith went on to say that in his opinion, there is a rather high initial investment for a relatively small volume of cases. Since a few university labs and Therapath already offer this service, its probably wise for most institutions of small or medium size to outsource this particular test. Finally, might these skin biopsies ultimately turn out to be a fad? Do these biopsies really provide useful information beyond what one could gain from clinical and electrophysiologic exam? Given these concerns, I'll likely recommend Therapath to any clinician looking for an epidermal nerve fiber density assessment.

Announcing the Forensic Neuropathology Initiative 2010

Today I feature a guest post from Dr. Peter Cummings (pictured), an emerging power player in the field of forensic neuropathology. Dr. Cummings appeared on this blog in July in connection to a People Magazine article about his investigation of a 1980 murder case. Today Dr. Cummings reappears as he attempts to harness the power of Web Pathology 2.0 to create a network among those who practice the tiny-but-important sub-sub-specialty of forensic neuropathology. Take it, Pete:

"The field of forensic neuropathology has expanded exponentially over the past few years and has seen the publication several new text books and the development of a one-year fellowship position in some medical examiner offices. With this growth the practicing neuropathologist who handles forensic brains needs to keep up with current research. In light of this, I proposed to Dr. David Louis (the current president of the American Association of Neuropathologists) that the upcoming AANP meeting have a dedicated forensic neuropathology session. Dr. Louis agreed and charged me with the task of drumming up interested individuals. Even though the area of forensic neuropathology has seen tremendous growth, it seems as though those of us practicing the 'dark art' are out of touch with each other. I have managed to get in touch with a few folks and have hopes of finding more of us forensic NPer's. My goal is to get people interested in submitting forensic-related abstracts for the June 2010 AANP meeting in Philadelphia. The submission deadline is February 5, 2010, so there is plenty of time. According to the powers-that-be at AANP, right now I have enough people for a dedicated poster session. If more people are interested, we could get a platform session. A formal decision will not be made regarding a poster or platform session until all of the abstracts are submitted. So, if you are interested, get in touch with me (at pathologypete@hotmail.com) so I can get a head count (no pun intended, but appreciated if you thought it was punny). Also, if you are practicing forensic neuropathology to any degree, still get in touch with me even if you don't want to prepare an abstract. I would like to hear from you. OK, lets get those abstracts cooking, there is power in numbers!!"

Should football be illegal?

Two neuropathologists are prominently spotlighted in an article by Malcolm Gladwell in the October 19 issue of The New Yorker. The article explores a provocative question raised by autopsy results on football players: namely, should football be illegal? Featured are Dr. Ann McKee (pictured), neuropathologist at the Veterans Hospital in Bedford, Massachusetts and Dr. Bennet Omalu, forensic neuropathologist and San Joaquin Valley (CA) chief medical examiner. Drs. McKee and Omalu have done some interesting autopsy work which suggests that the tau-positive chronic traumatic encephalopathy suffered by football players is much more common, even among high school players, than previously realized. As an example, McKee provides photomicrographs from a case of an 18-year-old high school football player and says: "He's got all this tau. This is frontal and this is insular.... This is completely inappropriate. You don't see tau like this in an 18-year-old. You don't see tau like this in a fifty year old."

You might counter that this is simply the result of a few bad-luck hits on the field, but research involving the University of North Carolina football team suggests otherwise. Players at UNC wear impact sensors in their helmets throughout the season. Results from these investigations suggests that even routine hits during practice can add up to cause concussions and, theoretically, set the stage for chronic traumatic encephalopathy. (On the first day of training camp one UNC lineman was recorded as having been hit in the head thirty-one times!)

Back in 1905, Gladwell reports, the question of whether football should be played in our nation's schools was raised to the level of the White House, when President Theodore Roosevelt called an emergency summit to discuss the issue. At the time, a professor at the University of Chicago called football a "boy-killing, man-mutilating, money-making, education-prostituting, gladiatorial sport". And in December of 1905, presidents of twelve prominent colleges met in New York and came within one vote of abolishing the sport at their institutions.

What does this mean for football in America? Nothing. Fans are willing to spend a lot of money to see men slam into each other's heads on the field. But, as a parent, you can do something. You can forbid your son from playing football.

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."

Is anyone assessing epidermal nerve fiber density in skin biopsies?

I recently received an advertising pamphlet from Therapath, a New York company offering to evaluate skin punch biopsy specimens in patients with suspected small fiber neuropathy. The pamphlet trumpets Therapath's proficiency, including "board certified neuropathologists meticulously reviewing cases". Although I have heard of this test, no clients of my practice have yet requested such a test. According to Therapath, the result is "reported as the average number of nerve fibers that cross the basement membrane at the dermal epidermal border, over a length of 1 mm. Making the correct diagnosis explains the symptoms, guides the evaluation for the underlying cause, and helps decide treatment". See the photomicrograph from Therapath's website of normal skin with small fibers (arrow) traversing the basement membrane (arrowhead) and coursing through the epidermis. Accompanying the pamphlet is a letter from "neuropathologist and laboratory director" William Harrington, MD in which he states that the American Academy of Neurology has added a practice guideline to include skin biopsy in the scope of practice when evaluating for polyneuropathies. He goes on to say that "skin biopsy for the determination of epidermal nerve fiber density is the most sensitive test for small fiber neuropathy". Therapath provides the clinician with a kit for biopsy collection and shipping to their facility at no extra charge. Eight to 12 days later, Therapath provides a full-color, quantitative laboratory report with images. If anyone has had experience with evaluating such biopsies, please comment on this post and provide us with your insights regarding the utility and technical requirements of this test. I'm not sure whether I would have to use a service such as Therapath's, or perform the service in-house. Thanks!

Pathology 2.0: The Time Has Come

You may not realize it, but by reading this blog post you are participating in "Pathology 2.0". What is Pathology 2.0? For that, read an edited transcript of remarks made by Dr. Keith J. Kaplan (pictured) at the College of American Pathologists Foundation June 12-14 "Futurescape of Pathology" conference in Rosemont, Illinois. Speaking of things 2.0, today is the opening day of the Health 2.0 conference in San Francisco. Subtitled "User-Generated Healthcare", the conference focuses on the ways in which Web 2.0 technology is being applied to healthcare today. Conference organizers define Health 2.0 on their website as follows: "Our definition is currently focusing on user-generated aspects of Web2.0 within health care but not directly interacting with the mainstream health care system. That means, a) search, b) communities, c) tools for individual and group consumer use. But clearly there are blurring boundaries between all these, and the question of connecting Health 2.0 user-generated content to the wider health care system—which hasn’t exactly adopted Web 1.0 with a flourish—is coming into closer focus as more clinicians and organizations start to use these technologies to communicate with consumers."

Online Biomedical Lectures for the Blue-Collar Neuropathologist

If you consider yourself a blue-collar neuropathologist, a nice resource has appeared on the web for you. Henry Stewart Talks, based in London, is providing free access to a wide variety of on-line biomedical lectures in the form of The Biomedical and Life Sciences Collection. One series of these talks focuses on neurodegenerative disease, which would be of particular interest to the practicing neuropathologist engaged in brain autopsy work. The talks are geared toward an audience looking for a more in-depth presentation than would be appropriate for a general pathologist or neurologist, but not so loaded with basic science as to be of no practical use. For now, Henry Stewart Talks is offering institutions, such as mine, free access to the talks on a trial basis. Alternatively, you can request a free trial as an individual by visiting the site. I recently watched a very nice lecture on the clinicopathologic aspects of frontotemporal dementia by Dr. John Hodges of Cambridge University (53 minutes) and a helpful talk by Dr. Peirluigi Gambetti of Case Western Reserve University on prion diseases (53 minutes). Hats off to Henry Stewart Talks for providing this resource!

A case of cerebral Baylisascariasis

A loyal reader sent in this wonderful photomicrograph from a recent case of cerebral Baylisascariasis (click on the picture to see it up close). A cause of eosinophilic meningoencephalitis, infection with Baylisascaris procyonis is typically characterized by necrosis and eosinophilic inflammation. Larvae are often encapsulated within fibrous tissue (reference 1). Although not particularly neurotropic, the larvae may reach the central nervous system and cause major tissue damage.

Baylisascaris procyonis is an intestinal roundworm endemic to the US raccoon population. Humans are infected by ingestion of worm eggs in raccoon feces. The median age for human infection is just over one year old, consistent with the propensity of young children to explore their environment orally (surprising that this behavior has not been naturally selected out of humans over the millenia!). I came across only one report of clinical recovery after infection (reference 2). Otherwise, cerebral Baylisascariasis results in either severe neurologic damage or death. That being said, subclinical infection has been suggested by a study in Chicago, which found 30 (8%) of 389 children 1–4 years of age were seropositive for B. procyonis, although none had experienced symptoms (reference 3).

The most common cause of eosinophilic meningitis in the United States is the presence of a ventriculoperitoneal shunt; but worldwide it is infection by Angiostrongylus cantonensis. In addition to Bayliscaris procyonis, other infectious causes of eosinophilic meningitis include Toxocara spp., Gnathostoma spinigerum, and neurocysticercosis (source: reference 2).

References:
1. Love S, et al, eds. Greenfield's Neuropathology, 8th edition. p. 1479.
2. Pai et al. Full recovery from Baylisascaris procyonis eosinophilic meningitis. Emerging Infectious Disease 13(6) p 928-30. June 2007
3. Brinkman WB, Kazacos KR, Gavin PJ, Binns HJ, Robichaud JD, O'Gorman M, et al. Seroprevalence of Baylisascaris procyonis (raccoon roundworm) in Chicago area children. In: Program and abstracts of the 2003 Annual Meeting of the Pediatric Academic Societies, Seattle, Washington; 2003 May 3–6. Abstract 1872. [cited 2007 Mar 29]. Available from http://www.abstracts2view.com/pasall/authorindex.php

Featured Neuropathologist: Craig Horbinski, MD, PhD

Today I profile Dr. Craig Horbinski (pictured), a rising star in the neuropathology firmament. If you follow the neuropathology literature, you are sure to hear about Craig in the coming decades as he sure to make a big impact on the field. After a short biographical sketch, Craig answers a few of my questions:

Craig Horbinski hails from snowy Buffalo, NY, where he did both his undergraduate training in Biology at Canisius College and a combined MD, PhD at the State University of New York at Buffalo. Craig’s work as a graduate student was on mechanisms of dendrite growth, requiring a lot of microscopy and morphometric analyses. After a 1-year postdoctoral research fellowship studying Parkinson Disease at the University of Pittsburgh, he did 3-year Anatomic Pathology residency at UPMC. During this time Craig developed an interest in oncogenesis, particularly as his residency training exposed him to cutting-edge molecular diagnostic approaches to neoplasms. Thus, when continuing his training as a fellow in neuropathology at Pitt, he focused his research on both the molecular diagnostics of gliomas and mechanisms underlying gliomagenesis, as well as the application of telemedicine to neuropathology. Upon completion of his neuropathology fellowship in July of 2009, Craig joined the faculty at the University of Kentucky in Lexington as an Assistant Professor in Neuropathology, where he is continuing his work on gliomagenesis and molecular diagnostics as an independent principal investigator. Craig is married to Christy and has a 1-year old son, Cedric. He and Christy are slated to adopt a baby from China, probably by early 2010.

1. Why did you decide to become a neuropathologist?

I’ve been attracted to the neurosciences since my sophomore year of college, which featured a fantastic course on neurobiology. Since I was already committed to being a physician, I thought neurology was the way to go (neurosurgery was out of the question). But as I went through medical school I discovered the field of pathology, in particular neuropathology. To me it seemed the best way to scratch both the research and clinical itches (so to speak), as neuropathology lends itself particularly well to those with combined-degree training.

2. Name a couple of important professional mentors. Why were they important to you?

The first person I have to acknowledge is Dennis Higgins, my thesis advisor back at SUNY Buffalo. He was a real gem, a pure scientist whose passion for science was both inspiring and infectious. It’s not an exaggeration to say I learned how to think like a scientist from him. Tragically he died of pancreatic cancer a few years ago; I think he would have been pleased to see how things have gone for me thus far. The second key person is Clayton Wiley, the Director of Neuropathology at the University of Pittsburgh. While I learned science from Dennis, I learned grantsmanship and administration from Clayton. He’s one of those exceedingly rare people who managed to succeed at all four pillars of an academic physician’s life: research, clinical, administration, and teaching. Plus he’s mastered the art of staying out of political brouhahas—not a trivial accomplishment in a big academic center. Even more intolerable is that he’s a terrific guy, very approachable, with a sharp, self-deprecating wit. Anyone who wants to know how to survive as a physician-scientist ought to emulate Clayton.

3. What advice would you give to a pathology resident interested in doing a neuropathology fellowship?

Be sure you are flexible with where you want to live. The job market for neuropathology is pretty good right now, but since brain tumors are relatively uncommon, only medium-to-large cities can typically sustain neuropathologists. That is, unless you are planning on doing full-time clinical, with some general surgical path mixed in. Another word of caution goes to those who want to develop an independent research program—most academic neuropath openings will claim they want you to do independently-funded research, but beware of red flags like being asked to commit 50% or more of your time to clinical work “until you get a grant” (which probably won’t happen if you’re devoting that much time to clinical), or splitting your clinical time between neuropath and general surgical path.

4. What city (other than Lexington, KY of course) would you like a future American Association of Neuropathologists meeting to be held and why?

I think Salt Lake City would be a neat change of pace from the typical destinations. It’s fairly easy to fly to, it’s relatively inexpensive, the weather’s good in June, and the mountain scenery is gorgeous.