Difference between revisions of "Brain autopsy"

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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, 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 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.
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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.
 
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Chronology at early infarction:
 
Chronology at early infarction:

Revision as of 11:20, 7 June 2021

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

Sample from the pituitary if it protrudes above the sella turcica. Further information: pituitary

Brain: 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

edit

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

Tissue selection

(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, vasculitis or infarction.

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:

Further information: Alzheimer's disease

Basal ganglia

A lacunar infarct in the thalamus.

Look for lacunar infarcts, which are most common in the deep nuclei of the brain.[6]

Infarction

Chronology at early infarction:

  • At first, injured neurons shrink and become eosinophilic, with condensed nuclei. Astrocytes swell (Alzheimer type II cells).[7]
  • After 6 to 8 hours, neutrophils have surrounded cerebral vessels and begin to infiltrate.[8]

Microscopy report

Example in normal findings:

((Standard sections of the cerebral cortex, basal ganglia, hippocampus, thalamus/substantia nigra, medulla oblongata and cerebellum 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. 
  6. Neuropsychology : a review of science and practice, volume III . Koffler, Sandra,, Mahone, E. (E. Mark),, Marcopulos, Bernice A.,, Johnson-Greene, Douglas Eric, 1962-, Smith, Glenn E.. New York, NY. 2018-12-17. ISBN 978-0-19-065256-2. OCLC 1078637067. 
  7. . Neuropathology, Chapter 2: Cerebral Ischemia and Stroke. Updated: October, 2017
  8. Jickling, Glen C; Liu, DaZhi; Ander, Bradley P; Stamova, Boryana; Zhan, Xinhua; Sharp, Frank R (2015). "Targeting Neutrophils in Ischemic Stroke: Translational Insights from Experimental Studies ". Journal of Cerebral Blood Flow & Metabolism 35 (6): 888–901. doi:10.1038/jcbfm.2015.45. ISSN 0271-678X. 

Image sources


Extermnal links