Neuropathology
Encyclopedia
Neuropathology is the study of disease
of nervous system tissue, usually in the form of either small surgical biopsies or whole autopsy brains. Neuropathology is a subspecialty of anatomic pathology, neurology
, and neurosurgery
. It should not be confused with neuropathy, which refers to disorders of the nerves (usually in the peripheral nervous system
).
tissue from the brain
and spinal cord to aid in diagnosis
of disease. The biopsy is usually requested after a mass is detected by radiologic imaging. As for autopsies, the principal work of the neuropathologist is to help in the post-mortem diagnosis of various forms of dementia and other conditions that affect the central nervous system.
Biopsies can also consist of the skin. Epidermal nerve fiber
density testing (ENFD) is a more recently developed neuropathology test in which a punch skin biopsy is taken to identify small fiber neuropathies by analyzing the nerve fibers of the skin. This pathology test is becoming available in select labs as well as many universities; it replaces the traditional sural nerve biopsy test as less invasive. It is used to identify painful small fiber neuropathies.
. In contrast, there are a number of independent university chairs in neuropathology and even institutes of neuropathology in German speaking countries due to a different historical background. A physician who specializes in neuropathology, usually by completing a fellowship after a residency in anatomical or general pathology, is called a neuropathologist. In day-to-day clinical practice, a neuropathologist is a consultant for other physicians. If a disease of the nervous system is suspected, and the diagnosis cannot be made by less invasive methods, a biopsy
of nervous tissue
is taken and sent to the neuropathologist, who examines it using a microscope or certain molecular methods to make a definitive diagnosis.
Many neuropathologists in Europe have a background in the clinical neurosciences (neurology, psychiatry) as well as pathology.
Neuropathology in the US System
Neuropathologists are physicians with either MD or DO medical school degrees. They must finish either 2 or 3 years of an anatomical pathology residency followed by 2 years of a neuropathology fellowship and be certified by the American Board of Pathology in both anatomical and neuropathology. It is also quite common for neuropathologists to have PhDs in a related field.
Neuropathology in the UK System
Neuropathologists are medically qualified practitioners who are registered with the General Medical Council
in the UK. A postgraduate qualification in neuropathology is obtained through training and an examination overseen by the Royal College of Pathologists
UK. A neuropathologist has training in anatomic pathology followed by training in relation to diagnosis of diseases of the nervous system and muscle. A specialist examination (called Part2) in neuropathology is run by the Royal College of Pathologists
UK.It is also quite common for neuropathologists to have PhDs in a related field.
In addition to examining central nervous system tissue, the neuropathologist usually is assigned the task of examining muscle and peripheral nerve biopsies. Muscle biopsies are taken to aid in the diagnosis of muscle diseases (such as polymyositis, mitochondrial myopathy, etc.). Peripheral nerve is assessed to help work up patients with suspected peripheral neuropathies secondary to such conditions as vasculitis and amyloidosis.
Neuropathology is a heavily research oriented field.
is considered one of the founders of modern neuroanatomy. Alois Alzheimer
, the person after whom Alzheimer's disease
is named, is considered an important early contributor to the field.
Stephen J. Nelson, M.D., of Florida, was the neuropathologist who examined Terri Schiavo at autopsy when she died in Pinellas County, Florida. Dr. Nelson also examined Anna Nicole Smith when she died in Broward County, Florida. Dr. Nelson holds the unusual combination of certification in anatomic pathology, forensic pathology, and neuropathology, all by The American Board of Pathology.
is the neuropathology journal with the highest impact factor. Some journals are sponsored by national or international neuropathology associations: Brain Pathology
is the official journal of the International Society of Neuropathology, Neuropathology & Applied Neurobiology
is sponsored by the British Neuropathological Society
, the Journal of Neuropathology and Experimental Neurology is the official journal of the American Association of Neuropathologists
(AANP) and "Neuropathology" is the official journal of the Japanese Society of Neuropathology.
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...
of nervous system tissue, usually in the form of either small surgical biopsies or whole autopsy brains. Neuropathology is a subspecialty of anatomic pathology, neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...
, and neurosurgery
Neurosurgery
Neurosurgery is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.-In the United States:In...
. It should not be confused with neuropathy, which refers to disorders of the nerves (usually in the peripheral nervous system
Peripheral nervous system
The peripheral nervous system consists of the nerves and ganglia outside of the brain and spinal cord. The main function of the PNS is to connect the central nervous system to the limbs and organs. Unlike the CNS, the PNS is not protected by the bone of spine and skull, or by the blood–brain...
).
Methodology
The work of the neuropathologist consists largely of examining biopsyBiopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
tissue from the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
and spinal cord to aid in diagnosis
Diagnosis
Diagnosis is the identification of the nature and cause of anything. Diagnosis is used in many different disciplines with variations in the use of logics, analytics, and experience to determine the cause and effect relationships...
of disease. The biopsy is usually requested after a mass is detected by radiologic imaging. As for autopsies, the principal work of the neuropathologist is to help in the post-mortem diagnosis of various forms of dementia and other conditions that affect the central nervous system.
Biopsies can also consist of the skin. Epidermal nerve fiber
Nerve fiber
A nerve fiber is a threadlike extension of a nerve cell and consists of an axon and myelin sheath in the nervous system. There are nerve fibers in the central nervous system and peripheral nervous system. A nerve fiber may be myelinated and/or unmyelinated. In the central nervous system , myelin...
density testing (ENFD) is a more recently developed neuropathology test in which a punch skin biopsy is taken to identify small fiber neuropathies by analyzing the nerve fibers of the skin. This pathology test is becoming available in select labs as well as many universities; it replaces the traditional sural nerve biopsy test as less invasive. It is used to identify painful small fiber neuropathies.
Focus of specialization
In many English speaking countries neuropathology is considered a subfield of anatomical pathologyAnatomical pathology
Anatomical pathology or Anatomic pathology is a medical specialty that is concerned with the diagnosis of disease based on the gross, microscopic, chemical, immunologic and molecular examination of organs, tissues, and whole bodies...
. In contrast, there are a number of independent university chairs in neuropathology and even institutes of neuropathology in German speaking countries due to a different historical background. A physician who specializes in neuropathology, usually by completing a fellowship after a residency in anatomical or general pathology, is called a neuropathologist. In day-to-day clinical practice, a neuropathologist is a consultant for other physicians. If a disease of the nervous system is suspected, and the diagnosis cannot be made by less invasive methods, a biopsy
Biopsy
A biopsy is a medical test involving sampling of cells or tissues for examination. It is the medical removal of tissue from a living subject to determine the presence or extent of a disease. The tissue is generally examined under a microscope by a pathologist, and can also be analyzed chemically...
of nervous tissue
Nervous tissue
Nervous tissue is one of four major classes of vertebrate tissue.Nervous tissue is the main component of the nervous system - the brain, spinal cord, and nerves-which regulates and controls body functions...
is taken and sent to the neuropathologist, who examines it using a microscope or certain molecular methods to make a definitive diagnosis.
Many neuropathologists in Europe have a background in the clinical neurosciences (neurology, psychiatry) as well as pathology.
Neuropathology in the US System
Neuropathologists are physicians with either MD or DO medical school degrees. They must finish either 2 or 3 years of an anatomical pathology residency followed by 2 years of a neuropathology fellowship and be certified by the American Board of Pathology in both anatomical and neuropathology. It is also quite common for neuropathologists to have PhDs in a related field.
Neuropathology in the UK System
Neuropathologists are medically qualified practitioners who are registered with the General Medical Council
General Medical Council
The General Medical Council registers and regulates doctors practising in the United Kingdom. It has the power to revoke or restrict a doctor's registration if it deems them unfit to practise...
in the UK. A postgraduate qualification in neuropathology is obtained through training and an examination overseen by the Royal College of Pathologists
Royal College of Pathologists
The Royal College of Pathologists, founded in 1962, was established to co-ordinate this development and maintain the internationally renowned standards and reputation of British pathology. Today the College advises on a vast range of issues relating to pathology...
UK. A neuropathologist has training in anatomic pathology followed by training in relation to diagnosis of diseases of the nervous system and muscle. A specialist examination (called Part2) in neuropathology is run by the Royal College of Pathologists
Royal College of Pathologists
The Royal College of Pathologists, founded in 1962, was established to co-ordinate this development and maintain the internationally renowned standards and reputation of British pathology. Today the College advises on a vast range of issues relating to pathology...
UK.It is also quite common for neuropathologists to have PhDs in a related field.
In addition to examining central nervous system tissue, the neuropathologist usually is assigned the task of examining muscle and peripheral nerve biopsies. Muscle biopsies are taken to aid in the diagnosis of muscle diseases (such as polymyositis, mitochondrial myopathy, etc.). Peripheral nerve is assessed to help work up patients with suspected peripheral neuropathies secondary to such conditions as vasculitis and amyloidosis.
Neuropathology is a heavily research oriented field.
Prominent historical figures in neuropathology
Santiago Ramon y CajalSantiago Ramón y Cajal
Santiago Ramón y Cajal ForMemRS was a Spanish pathologist, histologist, neuroscientist, and Nobel laureate. His pioneering investigations of the microscopic structure of the brain were original: he is considered by many to be the father of modern neuroscience...
is considered one of the founders of modern neuroanatomy. Alois Alzheimer
Alois Alzheimer
Aloysius "Alois" Alzheimer, was a German psychiatrist and neuropathologist and a colleague of Emil Kraepelin. Alzheimer is credited with identifying the first published case of "presenile dementia", which Kraepelin would later identify as Alzheimer's disease....
, the person after whom Alzheimer's disease
Alzheimer's disease
Alzheimer's disease also known in medical literature as Alzheimer disease is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death...
is named, is considered an important early contributor to the field.
A sampling of prominent currently practicing neuropathologists
Among prominent currently practicing neuropathologists are Drs. Dennis W. Dickson (Mayo Clinic), Mark Cohen (Case Western Reserve University), Richard Prayson (Cleveland Clinic), Douglas C. Miller (University of Missouri; until recently at NYU), John Trojanowski (University of Pennsylvania), Roger McLendon (Duke University) and John Donahue (Brown University). Dr. Donahue also happens to be a neurologist. Neuropathologists who are also neurologists used to be the norm, but now they are becoming a rare entity.Stephen J. Nelson, M.D., of Florida, was the neuropathologist who examined Terri Schiavo at autopsy when she died in Pinellas County, Florida. Dr. Nelson also examined Anna Nicole Smith when she died in Broward County, Florida. Dr. Nelson holds the unusual combination of certification in anatomic pathology, forensic pathology, and neuropathology, all by The American Board of Pathology.
Progress
A European Board Examination in Neuropathology which emphasizes the importance of proper training in the neurosciences is currently being established (www.euro-cns.org). The most recent international meeting of neuropathologists occurred in September 2006 in San Francisco, California, USA.Neuropathology journals
Academic neuropathology is served by several specialist neuropathology journals. Acta NeuropathologicaActa Neuropathologica
Acta Neuropathologica is a peer-reviewed scientific journal specialising in neuropathology published by Springer....
is the neuropathology journal with the highest impact factor. Some journals are sponsored by national or international neuropathology associations: Brain Pathology
Brain Pathology
Brain Pathology is the medical journal of the International Society of Neuropathology, published for them by John Wiley & Sons....
is the official journal of the International Society of Neuropathology, Neuropathology & Applied Neurobiology
Neuropathology & Applied Neurobiology
Neuropathology and Applied Neurobiology is a peer-reviewed medical journal in the field of neuropathology.It is published by Wiley-Blackwell for the British Neuropathological Society. The journal was established in 1974 and is published bimonthly. it's scope includes the publication of original...
is sponsored by the British Neuropathological Society
British Neuropathological Society
The British Neuropathological Society is a professional organisation dedicated to the science of neuropathology. It is one of several national societies composed of neuropathologists...
, the Journal of Neuropathology and Experimental Neurology is the official journal of the American Association of Neuropathologists
American Association of Neuropathologists
American Association of Neuropathologists, Inc. was established in the 1930s as a professional and educational organization representing American neuropathologists. It was incorporated in the State of Pennsylvania in May 1960. Currently, the membership consists of 800 scientists and physicians,...
(AANP) and "Neuropathology" is the official journal of the Japanese Society of Neuropathology.
External links
- http://www.aanp-jnen.com/ American Association of Neuropathologists
- http://www.bns.org.uk/ British Neuropathological Society
- http://www.euro-cns.org/start.php EuroCNS European Conferderation of Neuropathological Societies
- http://www.intsocneuropathol.com/ International Society of Neuropathology
- http://www.neuropathologyblog.blogspot.com/ Blog by neuropathologist Brian E. Moore, MD
- http://neuropathology-web.org Web site by Dimitri Agamanolis, M.D.