Neuropathology

I’ve always had a place in my heart for pathology—the fundamental basis for allopathic medicine. By this I mean that in diagnosing and treating disease, we’re concerned with the structure and function of the body’s organs and systems, their pathological disruptions, and the biochemical and genetic bases for such. I don’t mean to downplay the importance of patients’ emotional experiences, existential challenges, family dynamics, and other personal and social aspects of health and disease; these are important too. But what we are not concerned with is balancing the four humors or regulating the flow of qi.

Even in psychiatric practice, one of the first tasks in any diagnostic evaluation is to rule out an “organic” cause of the patient’s mental or behavioral dysfunction. This raises extremely interesting questions about structure-function relationships in the brain—is there truly a difference between “organic” and “psychiatric” disease, or is the latter just a brain disorder where the underlying structure-function relationships haven’t been fully elucidated? These sorts of questions are in part what drew me, and many others, to neurology, but that’s a topic for another day.

The bottom line is that if one is going to diagnose and treat disease in the allopathic paradigm, one must have at least some grasp of pathology. I actually spent a year as a pathology “fellow” between my M2 and M3 years and can attest that it was very helpful in understanding the diseases I later saw on the wards. There’s a huge difference between say, reading about congestive heart failure vs. actually squeezing with one’s own fingers the edema fluid from the lungs of a deceased CHF patient, or feeling and hearing the scalpel scrape and cut through his atherosclerotic coronaries. Similarly, directly inspecting a brain’s purulent meninges, its atrophic gyri, its depigmented midbrain, its foci of infarction, etc. brings a greater depth of understanding than simply reading about these conditions or viewing the pathologies on MRI.

To that end, I want to encourage residents to take advantage of learning opportunities in neuropathology. At our institution, we’re fortunate to have a neuropathologist with over 30 years of experience teaching residents. He has dozens of gross “museum cases” and clinico-pathological case reports and hundreds of slides, all with accompanying explanatory material for self-study. And we have brain cutting twice each week, which also serves as a reminder that we should refer our deceased patients for autopsy when appropriate—again, MRI doesn’t have all of the answers.

The specific purpose of this post is to bring to the residents’ attention an outstanding web resource for neuropathology. It’s an online textbook / lecture series / self-assessment tool developed by Dr. Dimitri Agamanolis of Akron Children’s Hospital and Northeast Ohio Medical University. The meat of it is a series of chapters on neurocytology, hypoxic / ischemic injury, CNS infections, demyelinating diseases, etc. Most of the chapters have an embedded video lecture that’s also accessible on Vimeo, but the material can be perused by reading alone if desired. Clicking on the thumbnail photomicrographs reveals enlargements with detailed captions. Most chapters have an associated quiz, and I think that working through all of the chapters and all of the quizzes would be great preparation for the RITE and boards. This is a very high-quality resource that Dr. Agamanolis has graciously published to the web for free; I wish to extend to him my thanks!

(I added a link to the site in the main menu above, under Clinical Neurology Resources→General Neurology).

About Justin A. Sattin

I'm a vascular neurologist and residency program director. I created this blog in order to share some thoughts with my resident and other colleagues, and to foster my own learning as well.
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