Difference between revisions of "Brain autopsy"

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{{Moderate-begin}}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:{{Moderate-end}}
 
{{Moderate-begin}}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:{{Moderate-end}}
 
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File:Location of CA3 area.jpg|thumb|These signs are mainly visible in the temporal lobes and hippocampus,<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 neurofibrillary tangles in Alzheimer's disease - annotated.jpg|Neurofibrillary tangles
 
File:Histopathology of amyloid plaque in Alzheimer's disease - annotated.jpg|Amyloid plaques
 
File:Histopathology of amyloid plaque in Alzheimer's disease - annotated.jpg|Amyloid plaques

Revision as of 09:56, 12 August 2020

Author: Mikael Häggström [note 1]

Gross processing

Comprehensiveness

Factors supporting a relatively more comprehensive autopsy and/or report, particularly in the inclusion of negated findings:

  • Lack of explanation from existing evidence. On the other hand, for example, upon finding an obvious aortic rupture, the rest of the autopsy is less relevant and may be relatively short.
  • Double-reading: If your report is likely to undergo double reading by another pathologist before sign-out, it needs to be more detailed, because the doctor who will do the double-reading then knows that you have looked at those locations.
  • Highly suspected locations, such as given from the referral.

On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))
Other legend

<< Decision needed between alternatives separated by / signs >>
{{Common findings / In case of findings}}
[[Comments]]
Organs or important regions are in bold in the report example, but does not need to be in an actual report.

Steps

edit

  • Weight the brain. Overall normal range (95% prediction interval) is 1100 to 1700 g,[1] +60g for males and -60g for females.[2]
  • Inspect: Grooves indicating herniation? Hemorrhages?
  • Dissect the basilar artery and circle of Willis, either before or after separation from the brain. [[If there is likely a need to demonstrate the case to an additional person later, the arteries of the skull base are preferably dissected after first separating them from the brain.]] Look mainly for thromboses.
  • Separate the brainstem, cerebellum and cerebrum, which may be done by first separating the former two together from the cerebrum.
Normal brain versus in Alzheimer's disease.
  • Slice each part, looking for hemorrhages and/or infarcts.
  • For the cerebrum, cut it into slices about 1 cm thick. It can be done from frontal to occipital, or by starting coronally into two halves at the level of the mammillary bodies and continuing in each direction from there.
  • At least in people aged over 65-75 years of age {{or with suggestive history}}, look for signs of Alzhemier's disease (see picture).


Report

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The meninges and venous sinuses are unremarkable. ((The skull is unremarkable. The calvarium is opened in the usual manner. The scalp and overlying fascia are not remarkable. The skull is <<normal in thickness {{/ somewhat thickened in the frontal areas}}. The cerebrospinal fluid is clear. The dura and venous sinuses are unremarkable. The leptomeninges are thin, shiny and non-irritated, with no visible bleeding or exudates. The superficial blood vessels are not congested. The sulci and gyri are <<normal {{/ flattened}}.

(No visible thrombi. No epidural, subdural or subarachnoid hematoma.)

The brain is symmetrical and weighs ___g. ( The cerebral and cerebellar hemispheres are of equal size, and have a normal weight of ___g. [[Men: 1.180 to 1.620 g. Women: 1.030 to 1.400 g]][3][4]
No signs of herniation (No grooves on the bases of the cerebrum or cerebellum.)

((The cerebral ventricles are of normal size, with normal linings.)) Cut surfaces ((after fixation)) of the cerebrum, cerebellum and brainstem show (normal gray and white parenchyma, and) no ((encephalomalacia, ))(hemorrhages, tumors or other) focal abnormalities. ((The gyral pattern is preserved.))
The basal cerebral arteries << are ordinary / {{have mild / moderate / severe atherosclerosis}}>> without aneurysms or occlusions.

  See also: General notes on reporting


Microscopy

((Take samples for microscopy from:

  • Cerebrum:
  • Frontal lobe
  • Hippocampus
  • Thalamus and substantia nigra
  • Cerebellum, including dentate nucleus
  • Basal ganglia
  • Medulla oblongata))

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

Substantia nigra

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:)

Microscopy report

Example in normal findings:

((Standard sections of the frontal lobe, thalamus/substantia nigra, cerebellum and basal ganglia show)) intact cytoarchitecture. There is no evidence of hemorrhage, tumor, metastatic disease or vasculitis.

Notes

  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. Govender, S; Lazarus, L; De-Gama, B. Z; Satyapal, K. S (2018). "Post-Mortem Brain Weight Reference Range for a Select South African Population ". International Journal of Morphology 36 (3): 915–920. doi:10.4067/S0717-95022018000300915. ISSN 0717-9502. 
  2. Kelley Hays; David S. (1998). Reader in Gender archaeology . Routlegde. ISBN 9780415173605. Retrieved on 2014-09-21. 
  3. Standard reference range: Molina, D. Kimberley; DiMaio, Vincent J.M. (2012). "Normal Organ Weights in Men ". The American Journal of Forensic Medicine and Pathology 33 (4): 368–372. doi:10.1097/PAF.0b013e31823d29ad. ISSN 0195-7910. 
  4. Standard reference range: Molina, D. Kimberley; DiMaio, Vincent J. M. (2015). "Normal Organ Weights in Women ". The American Journal of Forensic Medicine and Pathology 36 (3): 182–187. doi:10.1097/PAF.0000000000000175. ISSN 0195-7910. 
  5. Rapp, Michael A.; Schnaider-Beeri, Michal; Grossman, Hillel T.; Sano, Mary; Perl, Daniel P.; Purohit, Dushyant P.; Gorman, Jack M.; Haroutunian, Vahram (2006). "Increased Hippocampal Plaques and Tangles in Patients With Alzheimer Disease With a Lifetime History of Major Depression ". Archives of General Psychiatry 63 (2): 161. doi:10.1001/archpsyc.63.2.161. ISSN 0003-990X. 

Image sources