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

The International Society for Frontotemporal Dementias has been founded

The following is an email sent out this week from Bernardino Ghetti, MD, neuropathologist at Indiana University:

Dear Friends,

Bernardino Ghetti, MD

In October 2010, I had the distinct privilege to host the 7^th International Conference on Frontotemporal Dementias in Indianapolis, Indiana.  Hundreds of you from around the world participated in this exciting meeting.

While the social relevance of frontotemporal dementia (FTD) is recognized, we have lacked a scientific international society devoted to the exchange of knowledge on FTD, facilitation of scientific cooperation, promotion of education, and planning of logistics and financial support.  As you may remember, the idea of organizing an international scientific society of FTD researchers was launched during the 7^th International Conference.  This concept obtained an enthusiastic response.

Since that time, many of you have been asking about the status of the society.  I am happy to announce that the legal documents have been filed and the International Society for Frontotemporal Dementias has been founded.  The current board of directors is composed of the following scientists:

Arne Brun MD, PhD                David Knopman MD

Emanuele Buratti PhD             Ian Mackenzie MD

Bernardino Ghetti MD             Marsel Mesulam MD

Murray Grossman MD             Bruce Miller MD

Lars Gustafson MD, PhD         Manuela Neumann MD

John Hodges MD, PhD            Rosa Rademakers PhD

Andrew Kertesz MD                Julie Snowden PhD

                                                                         John van Swieten MD

There is still work to be done, but the society is taking shape and we are currently looking for funding to support a website.  The society will facilitate scientific exchanges between researchers involved in all areas of clinical and basic neuroscience related to frontotemporal dementias and promote scientific discoveries.  As we prepare to open the society for membership, our hope is to reach all of you who have been an active part of the progress for the understanding of FTD and the care of people affected by this devastating disease. Our next step is to develop a website and facilitate the application for membership.  The membership fee will be $200.  Please let us know if you are interested in being a part of the International Society for Frontotemporal Dementias, or would also be interested in serving as part of a committee. 

I am truly convinced that this is a necessary step for the advancement of our knowledge of FTD.  I look forward to working with you in the future.

Regards,

Bernardino Ghetti, MD

For the Board of the International Society for Frontotemporal Dementias

The International Society for Frontotemporal Dementias can be reached at isftd.org@gmail.com