View source for Brain autopsy

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|author1=[[User:Mikael Häggström|Mikael Häggström]]
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'''[[Autopsy]]''' of the '''[[brain]]''':</noinclude>
==Gross processing==
<noinclude>{{Autopsy - comprehensiveness|subsection=yes|otherlegend=yes}}</noinclude>
===Steps===
Sample from the '''pituitary''' if it protrudes above the sella turcica. {{further|pituitary|linebreak=no}}
Brain: {{Brain - autopsy gross processing}}
[[File:Streptococcus pneumoniae meningitis, gross pathology 33 lores.jpg|thumb|170px|Brain with bacterial meningitis: The dura is retracted to show leptomeninges with edema and multiple small hemorrhagic foci.]]

===Report===
{{Central nervous system - Autopsy report}}
{{Reporting}}

==Microscopy==
===Tissue selection===
[[File:Standard sections of brain.jpg|thumb|370px|Gross pathology of a brain after sectioning, showing a normal brain with the cerebrum cut in coronal sections, and the cerebellum, pons and medulla cut in horizontal sections. Standard sections for microscopic examination are annotated.]]
{{Moderate-begin}}Take samples for microscopy from:
*Cerebrum:
:*Frontal lobe
:*Hippocampus
:*Thalamus and substantia nigra
*Cerebellum, including dentate nucleus
*Basal ganglia
*Medulla oblongata{{Moderate-end}}

Look for any hemorrhage, tumor, metastatic disease, vasculitis or infarction.

===Substantia nigra===
[[File:Histological sample of Substantia nigra in Parkinson's disease.jpg|thumb|Substantia nigra in '''Parkinson's disease''': A. Pars compacta neuron with a Lewy body, extracellular neuromelanin and pigment-laden macrophages. B. Alpha-synuclein-positive Lewy neurit.]]
In people over about 60 years of age, or in a history of suspected Parkinson's disease, look at the pars compacta for Lewy bodies and any alpha-synuclein-positive neurites, indicating Parkinson's disease.

===Hippocampus===
In people over about 60 years of age, or in a history of suspected '''[[Alzheimer's disease]]''', look for its main signs in the hippocampus:
<gallery mode=packed heights=200>
File:Location of CA3 area.jpg|thumb|These signs are mainly visible in the temporal lobes and hippocampus proper,<ref name="RappSchnaider-Beeri2006">{{cite journal|last1=Rapp|first1=Michael A.|last2=Schnaider-Beeri|first2=Michal|last3=Grossman|first3=Hillel T.|last4=Sano|first4=Mary|last5=Perl|first5=Daniel P.|last6=Purohit|first6=Dushyant P.|last7=Gorman|first7=Jack M.|last8=Haroutunian|first8=Vahram|title=Increased Hippocampal Plaques and Tangles in Patients With Alzheimer Disease With a Lifetime History of Major Depression|journal=Archives of General Psychiatry|volume=63|issue=2|year=2006|pages=161|issn=0003-990X|doi=10.1001/archpsyc.63.2.161}}</ref> with following images taken from its CA3 area, marked in box.
File:Histopathology of neurofibrillary tangles in Alzheimer's disease - annotated.jpg|Neurofibrillary tangles
File:Histopathology of amyloid plaque in Alzheimer's disease - annotated.jpg|Amyloid plaques
Histopathology of granulovacuolar degeneration in Alzheimer's disease - annotated.jpg|Granulovacuolar degeneration
</gallery>
{{Further|Alzheimer's disease}}

===Basal ganglia===
[[File:Histopathology of a lacunar cerebral infarct.jpg|thumb|220px|A '''[[lacunar infarct]]''' in the thalamus.]]
Look for '''[[lacunar infarct]]s''', which are most common in the deep nuclei of the brain.<ref>{{Cite book|title=Neuropsychology : a review of science and practice, volume III|others=Koffler, Sandra,, Mahone, E. (E. Mark),, Marcopulos, Bernice A.,, Johnson-Greene, Douglas Eric, 1962-, Smith, Glenn E.|isbn=978-0-19-065256-2|location=New York, NY|oclc=1078637067|date = 2018-12-17}}</ref>

===Infarction===
Attempt to estimate the '''age''' of any infarct. Also look at '''blood vessels''' for thrombus or stenosis.
<gallery mode=packed heights=190>
File:Histopathology of thalamus infarction at approximately 24 hours, low magnification, annotated.jpg|On low-power, look for areas of edema, as pale areas that do not conform to anatomic borders. This case is at approximately 24 hours.
File:Histopathology of thalamus infarction at approximately 24 hours, high magnification, annotated.jpg|thumb|If found, or if there is clinical suspicion of infarction in the area, look at high magnification in the pale areas for signs of infarction: The neurons become hypereosinophilic and there is an infiltrate of neutrophils. There is slight edema and loss of normal architecture in the surrounding neuropil.
File:Gross pathology of an old cerebral stroke, annotated.jpg|Gross pathology of an old stroke in the left posterior parietal lobe.
</gallery>
Chronology at early infarction:
*At first, injured '''neurons''' shrink and become eosinophilic, with condensed nuclei. Astrocytes swell (Alzheimer type II cells).<ref>{{cite web|url=https://neuropathology-web.org/chapter2/chapter2aHIE.html|title=Neuropathology, Chapter 2: Cerebral Ischemia and Stroke|Author=Dimitri P. Agamanolis, M.D.}} Updated: October, 2017</ref>
*After 6 to 8 hours, '''neutrophils''' have surrounded cerebral vessels and begin to infiltrate.<ref name="JicklingLiu2015">{{cite journal|last1=Jickling|first1=Glen C|last2=Liu|first2=DaZhi|last3=Ander|first3=Bradley P|last4=Stamova|first4=Boryana|last5=Zhan|first5=Xinhua|last6=Sharp|first6=Frank R|title=Targeting Neutrophils in Ischemic Stroke: Translational Insights from Experimental Studies|journal=Journal of Cerebral Blood Flow & Metabolism|volume=35|issue=6|year=2015|pages=888–901|issn=0271-678X|doi=10.1038/jcbfm.2015.45}}</ref>
A more detailed chronology is as follows:<ref name="pmid19690757">{{cite journal| author=Mărgăritescu O, Mogoantă L, Pirici I, Pirici D, Cernea D, Mărgăritescu C| title=Histopathological changes in acute ischemic stroke. | journal=Rom J Morphol Embryol | year= 2009 | volume= 50 | issue= 3 | pages= 327-39 | pmid=19690757 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19690757  }} </ref>
{| class="wikitable"
! Finding !! Appearance
|-
| Eosinophilic (red) neurons 
| 6 hours<ref>{{cite web|url=https://learn.chm.msu.edu/neuropath/content/cytopathology/CP_5.html|title=IB. Neurons - pathological changes|website=Michigan State University|accessdate=2022-01-07}}</ref> -35 days
|-
| Polymorphonuclear leukocytes
| 1-37 days
|-
| Other acute neuronal injuries 
| 1-60 days
|-
| Coagulative necrosis 
| 1 day - 5 years
|-
| Spongiosis of surrounding tissue
| 1 day and older
|-
| Astrogliosis (gemistocytes)
| 2 days and older
|-
| Neo-vascularization
| 3 days and older
|-
| Hemosiderin pigment
| 3 days and older
|-
| Mononuclear inflammatory cells
| 3 days–50 years
|-
| Macrophages
| 3 days–50 years
|-
| Cavitation
| 12 days or older
|}

===Common normal findings===
<gallery mode=packed heights=200>
File:Histopathology of brain sand (corpus arenaceum) in cerebral white matter.jpg|'''Brain sand''' ('''corpus arenaceum''') in cerebral white matter, which are age related changes that generally do not need reporting.<noinclude>
File:Histopathology of postmortem bacterial growth in a cerebral blood vessel.jpg|'''Postmortem bacterial growth''', with the absence of inflammation disproving pre-mortem presence. It has intra- and perivascular location.</noinclude>
</gallery>

===Microscopy report===
Example in normal findings:
{|class=wikitable
| {{Comprehensive-begin}}Standard sections of the cerebral cortex, basal ganglia, hippocampus, thalamus/substantia nigra, medulla oblongata and cerebellum show{{Comprehensive-end}} intact cytoarchitecture. There is no evidence of hemorrhage, tumor, metastatic disease or vasculitis.
|}

{{Bottom}}

==External link==
*[https://brains.anatomy.msu.edu/brains/human/index.html The Human Brain Atlas], including [https://brains.anatomy.msu.edu/brains/human/coronal/2000_fiber_labelled.html scrollable labeled coronal planes]