Dr. Doug Anthony becomes Chief-of-Pathology at Brown-affiliated hospitals

Excerpts from a message from Timothy J. Babineau, MD, President and Chief Executive Officer, Rhode Island Hospital and The Miriam Hospital

We are pleased to announce the appointment of Douglas C. Anthony, MD, PhD, as chief of pathology at Rhode Island Hospital and The Miriam Hospital, effective February 1, 2012. A neuropathologist, Dr. Anthony will lead the clinical, educational and research pathology programs for Lifespan, as well as help to bridge pathology and the neurosciences through the Norman Prince Neuroscience Institute.

Douglas C. Anthony, MD, PhD

Dr. Anthony comes to Rhode Island Hospital from the University of Missouri, where he is the chair of the department of pathology and anatomical sciences and professor of neurology.  At the University of Missouri Health Care he serves as chief of pathology and medical director of pathology clinical laboratories. He also serves as a pathologist at the Harry S. Truman Veterans Administration Medical Center, Women and Children’s Hospital, and the Ellis Fischel Cancer Center, and as a neuropathologist for the Office of the Medical Examiner in Boone, Callaway and Greene counties in Missouri.  Previously, he was on the faculty at Harvard Medical School and served as a neuropathologist at Boston Children’s Hospital, Brigham and Women’s Hospital, and as a neuropathologist consultant to the Office of the Chief Medical Examiner for the Commonwealth of Massachusetts.

He has won numerous awards, including the Dr. Edison H. and Sallie Y. Miyawaki Teaching Award in Neurosciences at Harvard Medical School; the Excellence in Education Award in pre-clinical sciences at the University of Missouri; and the Order of Socrates award at the School of Medicine at the University of Missouri.

Dr. Anthony’s appointment further demonstrates our commitment to becoming a leader in the neurosciences, and we are confident that he will be a tremendous asset to our clinical team.  Please join me in welcoming and congratulating Dr. Anthony.

NIH Loan Repayment Program a godsend for young neuropathologists interested in research

Today I feature a guest post from the illustrious Dr. Mike Lawlor.

Hi Everyone,

I'd just like to tell everyone about a program that the NIH offers, which may be of great interest to Neuropathology Fellows, Research Fellows, and Junior Faculty.  It's called the NIH Loan Repayment Program (LRP), and it's designed to encourage people with an interest in research to remain in the academic research environment.  From what I've heard, the NIH created this program so that people with lots of student loans (mostly medical doctors) with an interest in research would not give up their research careers due to their loan debt.

I just got an email from the LRP people, and they now have a webinar available to help people apply.  The link for the webinar is: http://bit.ly/nihlrptutorial 

Michael W. Lawlor, MD, PhD

The award offers up to $35,000 per year for up to two years, and you're able to apply for renewals whenever it runs out.  This counts as income, but the NIH also pays the federal income tax on this grant for you.  I ended up owing about $2000 in state tax every year for having the award, but that doesn't seem like much as you watch your student loans disappear.

Here's what you'll need:

1) The grant application, which can be found this site.  The forms aren't too labor-intensive, and you need to propose a 2-year research program and be able to guarantee a 50% effort commitment to the research.

2) A bunch of info on your student loans, most/all of which can be found on your monthly statements.  Your student loan burden needs to exceed a certain amount before you qualify, and the amount you need is dependent on your income.  Given the non-stellar income of most neuropath fellows and research fellows, it's actually pretty easy to qualify on financial grounds.  You may continue to apply for renewals as long as you continue to meet the eligibility requirements.

3) Someone to vouch for you.  Your research adviser will need to reply to an email that confirms that you are devoting 50% effort to your research every quarter.  After that confirmation is made, and you confirm that the prior payment made it to the right account, they apply a payment to your educational loans.

Anyway, I've been in this program for the past 2 years, had it renewed for another year, and am in the process of writing another renewal.  It really is a fantastic program with excellent support.  The next deadline is November 15th, so there's definitely time for you guys to put something together.  Once you submit the application, you'll hear nothing for about 6 months, and then they'll ask you for some updated student loan information if you've made it through their scientific review process.  The application cycle is once per year.

I hope that this helps some of you, and good luck!

Thanks for this helpful information, Mike!

Treatable Neurological Disorders Misdiagnosed as Creutzfeldt-Jakob Disease

A case of primary CNS angiitis thought to be sCJD

Dr. Mark Cohen and a team of workers at Case Medical Center in Cleveland, Ohio have published an important article in the Annals of Neurology entitled Treatable Neurological Disorders Misdiagnosed as Creutzfeldt-Jakob Disease (Ann Neurol 2011;70:437–444). Why is this article important? Well, because mistaking a survivable, treatable disorder for a fatal, non-treatable disorder is not optimal. Cohen's team reviewed the pathologic diagnoses of 1,106 patients who were referred for potential prion disease to the National Prion Disease Pathology Surveillance Center (NPDPSC) at Case Western Reserve University from 2006 to 2009. About one-third of the cases did not have prion disease, with Alzheimer disease and vascular disease being the most common conditions accounting for dementia. Further, about one-quarter of the non-prion cases had treatable diseases, including immune-mediated disorders, neoplastic disorders such as lymphoma, as well as infectious and metabolic disorders. The immune-mediated disorders included primary angiitis of the CNS, acute disseminated encephalomyelitis, limbic encephalitis, neurosarcoidosis, paraneoplastic cerebellar degeneration, and one case of Wegener granulomatosis. Of note, more than half of patients with a treatable dementia had a positive CSF 14-3-3 protein test, highlighting the danger of relying too heavily on this test in making a diagnosis of sporadic Creutzfeldt-Jakob disease (sCJD). It turns out that the most specific test for distinguishing CJD from other diseases was magnetic resonance imaging. Drs. David Perry and Michael Geschwind, in a review of this study in the September 2011 issue of Nature Reviews Neurology, (Perry, D. C. & Geschwind, M. D. Nat. Rev. Neurol. 2011:7, 479–480) write: "The fact that many of the non-prion diagnoses in the present study were potentially treatable RPDs [rapidly progressive dementias] should prompt thorough diagnostic testing in patients who are suspected of having sCJD, in order to rule out mimics. The use of CSF testing, contrast-enhanced MRI, and autoimmune antibody screening is supported by this study."

Attractive Neuropathology Postdoc Position in Neurodegenerative Disease Now Available at UCSF

Lea T. Grinberg, MD, PhD.

I recently received an email from Lea T. Grinberg, MD, PhD, a neuropathologist originally from Sao Paulo, Brazil now working at UCSF. She is recruiting a postdoc to work with her. Dr. Grinberg specializes in aging and neurodegenerative diseases and was recently awarded an R01 grant to study early stages of AD and FTLD-TDP in postmortem human tissue. She has access to a large brain bank associated with the Brazilian Aging Brain Study Group as well as the UCSF Memory and Aging Center brain bank. The postdoc will learn state-of-the-art methods for studying human post mortem brains, such as stereology, immunohistochemistry and fluorescence, computer assisted 3D reconstruction, and whole brain processing. She writes of the UCSF Memory and Aging Center: "We are a team of 150 individuals and the division promotes weekly grand rounds, journal clubs, lab meetings and regular CPC sessions. I believe it is an excellent opportunity for a young neuropathologist aiming to have a career in neurodegenerative disease."

I would say so! Here's the official job listing:

Post Doctoral Position in Neurodegenerative Diseases

NIH-supported post-doctoral position is immediately available for a qualified and highly motivated researcher to study early stages of neurodegenerative disease in human postmortem tissue

The fellow will pursue a series of related experiments regarding brain areas involved in very early clinical stages of Alzheimer’s disease and frontotemporal dementia. The successful candidate will have access to very difficult to get tissue belonging to cognitively normal elderly who already showed neurodegenerative changes in the brain. In addition, the fellow will be trained in state-of-the-art neuropathological/neuroanatomical processing and sophisticated graphic and reconstruction software. The fellow will have the opportunity of further participate in ongoing experimental studies.

Preferred Qualifications
Strong interest in neurodegenerative disease

Training in quantitative neuropathology or neuropathology is a plus.

This project is part of a close collaboration with other groups; therefore, candidates must have the ability to work in an international team, show organizational skills, and be driven by an interest in a multidisciplinary research setting

Applicants should possess a recent (within last three years) MD or PhD degree in the neuropathology/neuroanatomy/ neurosiciences with strong experience in stereology.

Applicants should send a CV and 3 letters of recommendation to Dr. Grinberg lea.grinberg@ucsf.edu

Bernd Scheithauer Has Died

A very sad letter from the Mayo Clinic received today:

Subject: Bernd Scheithauer

I just learned that Bernd Scheithauer, my treasured friend and colleague with whom we all had worked clinically or in the laboratory, was found dead at his home today.  He was not feeling well at work yesterday, and apparently died of natural causes at his home last evening or this morning.

Bernd was a rare individual and an academic giant.

Bernd had a deliciously naughty sense of humor and --with 24 indexed articles already in print this year-- I can just see him looking down on us, giggling, and saying, "Bill, take notice; publishing and perishing are not mutually exclusive."

I will certainly miss him.

Bill

William L. Lanier, M.D
Editor-in-Chief
Mayo Clinic Proceedings
Rochester, Minnesota  USA

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.

THE 5 HOTTEST TOPICS IN NEUROPATHOLGOY TODAY

By consensus, I present to you the five hottest topics in neuropathology today:

1. Chronic Traumatic Encephalopathy - There is an emerging recognition of CTE among those who have played contact sports. The elucidation of CTE will continue to have major public health policy implications.

2. Molecular Subtyping of Brain Tumors - For example, determination of the presence of O(6)-methylguanine DNA methyltransferase (MGMT) activity as a prognosticator of response to alkylating chemotherapy in gliomas is becoming increasingly important to our clinical neuro-oncology colleagues. Other molecular tests that are gaining popularity include IDH1 and EGFR. Molecular profile panels will become the standard of practice in the coming decades.

3. Brain Tumor Stem Cells - Questions about their existence and potential as targets for therapy have energized neuro-oncologic research.


4. Role of Microvascular Disease in Expression and Pathogenesis of Alzheimer Disease - The concept that Alzheimer disease may have a vascular pathogenesis may radically change the way the disease is prevented and treated.

5. Molecular Developments in Frontotemporal Lobar Degeneration -  As UCSF neurologist Bruce Miller, MD said: "Classification of FTLD is moving from a syndromic approach toward one based upon neuropathology and genetics." In particular, the description of the TDP-43 proteinopathies has had a major impact on our understanding of a previously unrecognized form of dementing disease.

There you have it. Thank you to everyone who contributed to this list. I think that it will help raise our collective eyes to the horizon.

What are the five hottest topics in neuropathology today?

What are the most promising or exciting topics in neuropathology today? Put up your list in the comments. Off the top of my head, in surgical neuropathology, the discussion regarding the utility of MGMT testing on high-grade gliomas (and whether PCR or IHC means of analysis) appears to be a timely topic. In non-surgical neuropathology, Chronic Traumatic Encephalopathy has been in the news lately. And what about TDP-43 protein in FTLD and MND? Come up with your own list and place in the comments. If we, as a virtual community, can come up with five of the most provocative topics in the field, I'll put them up on my next post.

"Coolest Picture Ever" of Baló’s Concentric Sclerosis

Dr. Mark Cohen, neuropathologist at Case Western Reserve University, sent me these "Images in Clinical Medicine" from the August 25, 2011 edition of the New England Journal of Medicine.  The accompanying text is as follows:

"A 25-year-old, left-handed man with known relapsing–remitting multiple sclerosis presented with a mild, nonfluent aphasic syndrome and left facial paresis that had developed within the previous 5 days. Magnetic resonance imaging (MRI) scans of the brain revealed a large lesion with a concentric-ring pattern consisting of alternating bands of higher and lower signal intensity (axial T2-weighted image above; sagittal image below). Although large in diameter, the lesion had only a minor mass effect. Baló’s concentric sclerosis, described in 1928 by Jószef Baló as a variant of acute multiple sclerosis, is histopathologically characterized by alternating layers of myelinated and demyelinated tissue. On MRI, Baló-like lesions are defined as two or more alternating bands of differing signal intensities. They may occur as solitary lesions, along with the plaques typically seen in multiple sclerosis, or (rarely) in the context of other disorders, such as neuromyelitis optica or viral infections of the central nervous system. The patient’s symptoms responded well within 1 week after the start of high-dose intravenous glucocorticoid therapy. On follow-up imaging 4 weeks later, both the size of the lesion and gadolinium enhancement had decreased."

Dr. Cohen's comment: "Coolest picture ever (if only it had path to go with it)." Agreed.