Difference between revisions of "Brain autopsy"

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===Basal ganglia===
 
===Basal ganglia===
[[File:Histopathology of a lacunar cerebral infarct.jpg|thumb|220px|A '''lacunar infarct''' in the thalamus.]]
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[[File:Histopathology of a lacunar cerebral infarct.jpg|thumb|220px|A '''[[lacunar infarct]]''' in the thalamus.]]
Look for lacunar infarcts, 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>
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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===
 
===Infarction===

Revision as of 08:55, 19 July 2021

Author: Mikael Häggström [notes 1]
Autopsy of the brain:

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.[notes 2] 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. 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

Attempt to estimate the age of any infarct. Also look at blood vessels for thrombus or stenosis.

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]

A more detailed chronology is as follows:[9]

Finding Appearance
Eosinophilic (red) neurons 1-35 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

{{further|

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.
  2. The arteries of the skull base are preferably dissected after separation from the brain if there is a need to demonstrate the case.

Main page

References

Extermnal links

  • 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. 
  • Kelley Hays; David S. (1998). Reader in Gender archaeology . Routlegde. ISBN 9780415173605. Retrieved on 2014-09-21. 
  • 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. 
  • 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. 
  • 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. 
  • 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. 
  • . Neuropathology, Chapter 2: Cerebral Ischemia and Stroke. Updated: October, 2017
  • 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. 
  • Mărgăritescu O, Mogoantă L, Pirici I, Pirici D, Cernea D, Mărgăritescu C (2009). "Histopathological changes in acute ischemic stroke. ". Rom J Morphol Embryol 50 (3): 327-39. PMID 19690757. Archived from the original. .