Neuropathology is the study of
disease
A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
of nervous system tissue, usually in the form of either small surgical biopsies or whole-body autopsies. Neuropathologists usually work in a department of
anatomic pathology
Anatomical pathology (''Commonwealth'') or Anatomic pathology (''U.S.'') is a medical specialty that is concerned with the diagnosis of disease based on the gross examination, macroscopic, Histopathology, microscopic, biochemical, immu ...
, but work closely with the clinical disciplines of
neurology
Neurology (from el, wikt:νεῦρον, νεῦρον (neûron), "string, nerve" and the suffix wikt:-logia, -logia, "study of") is the branch of specialty (medicine), medicine dealing with the diagnosis and treatment of all categories of co ...
, and
neurosurgery
Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peri ...
, which often depend on neuropathology for a diagnosis. Neuropathology also relates to
forensic pathology
Forensic pathology is pathology that focuses on determining the cause of death by examining a corpse. A post mortem examination is performed by a medical examiner or forensic pathologist, usually during the investigation of criminal law cases an ...
because brain disease or brain injury can be related to
cause of death
In law, medicine, and statistics, cause of death is an official determination of conditions resulting in a human's death, which may be recorded on a death certificate. A cause of death is determined by a medical examiner. The cause of death is ...
. Neuropathology should not be confused with
neuropathy
Peripheral neuropathy, often shortened to neuropathy, is a general term describing disease affecting the peripheral nerves, meaning nerves beyond the brain and spinal cord. Damage to peripheral nerves may impair sensation, movement, gland, or o ...
, which refers to disorders of the nerves themselves (usually in the
peripheral nervous system
The peripheral nervous system (PNS) is one of two components that make up the nervous system of bilateral animals, with the other part being the central nervous system (CNS). The PNS consists of nerves and ganglia, which lie outside the brain ...
) rather than the tissues. In neuropathology, the branches of the specializations of nervous system as well as the tissues come together into one field of study.
Methodology
The work of the neuropathologist consists largely of examining
autopsy
An autopsy (post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of death or to evaluate any di ...
or
biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...
tissue from the
brain
A brain is an organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as vision. It is the most complex organ in a v ...
and
spinal cord
The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the spi ...
to aid in
diagnosis
Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engin ...
of disease. Tissues are also observed through the eyes, muscles, surfaces of organs, and tumors. The biopsy is usually requested after a mass is detected by radiologic imaging, the imaging in turn driven by presenting signs and symptoms of a patient. CT scans are also used to discover issues in the patient. As for autopsies, the principal work of the neuropathologist is to help in the post-mortem diagnosis of various forms of dementia and other conditions that affect the central nervous system. Tissue samples are researched within the lab for diagnosis as well as forensic investigations.
Biopsies can also consist of the skin.
Epidermal
The epidermis is the outermost of the three layers that comprise the skin, the inner layers being the dermis and hypodermis. The epidermis layer provides a barrier to infection from environmental pathogens and regulates the amount of water relea ...
nerve fiber density testing (ENFD) is a more recently developed neuropathology test in which a punch skin biopsy is taken to identify small fiber neuropathies by analyzing the nerve fibers of the skin. This pathology test is becoming available in select labs as well as many universities; it replaces the traditional sural nerve biopsy test as less invasive. It is used to identify painful small fiber neuropathies.
Neuropathologists work in hospital labs and clinics, universities, or with the government depending on the situation. They often do not work with patients but only with medical professionals or other officials behind the scene. They research using information given to them by other neurologists and/ or physicians. Neuropathologists may also research in coroner's or morgue offices for forensic projects. The ultimate goal of neuropathologists is to find the medical issue and then formulate a timeline in which to cure the patient's tissue.
Focus of specialization
In many English-speaking countries neuropathology is considered a subfield of
anatomical pathology
Anatomical pathology (''Commonwealth'') or Anatomic pathology (''U.S.'') is a medical specialty that is concerned with the diagnosis of disease based on the macroscopic, microscopic, biochemical, immunologic and molecular examination ...
. In contrast, there are a number of independent university chairs in neuropathology and even institutes of neuropathology in German-speaking countries due to a different historical background. A physician who specializes in neuropathology, usually by completing a fellowship after a residency in anatomical or general pathology, is called a neuropathologist. In day-to-day clinical practice, a neuropathologist is a consultant for other physicians. If a disease of the nervous system is suspected, and the diagnosis cannot be made by less invasive methods, a
biopsy
A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a diseas ...
of
nervous tissue
Nervous tissue, also called neural tissue, is the main tissue component of the nervous system. The nervous system regulates and controls body functions and activity. It consists of two parts: the central nervous system (CNS) comprising the brain ...
is taken and sent to the neuropathologist, who examines it using a microscope or certain molecular methods to make a definitive diagnosis.
Many neuropathologists in Europe have a background in the clinical neurosciences (neurology, psychiatry) as well as pathology.
In the US system
Neuropathologists are physicians with a
Doctor of Medicine
Doctor of Medicine (abbreviated M.D., from the Latin language, Latin ''Medicinae Doctor'') is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the M.D. denotes a profes ...
(MD) or
Doctor of Osteopathic Medicine
Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become lice ...
(DO) degree. They must finish either 3 or 4 years of an anatomical pathology residency followed by 2 years of a neuropathology fellowship and be certified by the
American Board of Pathology
The American Board of Pathology (ABPath) is one of 24 member boards of the American Board of Medical Specialties. This organization was assembled in May 1936, under the approval of the Advisory Board for Medical Specialties (ABMS) and the American ...
in both anatomical and neuropathology. This is less specialized neuropathology training than in most other countries. It is also quite common for neuropathologists to have a
Ph.D.
A Doctor of Philosophy (PhD, Ph.D., or DPhil; Latin: or ') is the most common degree at the highest academic level awarded following a course of study. PhDs are awarded for programs across the whole breadth of academic fields. Because it is ...
in a related field. Neuropathologists must have strong communication abilities as they must analyze results and be able to explain the results to patients and/ or physicians (in paper or verbally).
In the UK/Canadian/Commonwealth system
Neuropathologists are medically qualified practitioners who are registered with the
General Medical Council
The General Medical Council (GMC) is a public body that maintains the official register of medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the public" by c ...
in the UK. A postgraduate qualification in neuropathology is obtained through training and an examination overseen by the
Royal College of Pathologists
The Royal College of Pathologists (RCPath) is a professional membership organisation.
Its main function is the overseeing of postgraduate training, and its Fellowship Examination (FRCPath) is recognised as the standard assessment of fitness to pr ...
UK. A neuropathologist has training in anatomic pathology followed by training in relation to diagnosis of diseases of the nervous system and muscle.
The training in other European and commonwealth countries is similar.
In Canada, Neuropathologists complete a 5-year Royal College of Physicians and Surgeons of Canada Neuropathology residency including a year of clinical medicine and a year of anatomical pathology.
It is quite common for neuropathologists to have PhDs in a related field.
In addition to examining central nervous system tissue, the neuropathologist usually is assigned the task of examining muscle and peripheral nerve biopsies. Muscle biopsies are taken to aid in the diagnosis of muscle diseases (such as
polymyositis
Polymyositis (PM) is a type of chronic inflammation of the muscles (inflammatory myopathy) related to dermatomyositis and inclusion body myositis. Its name means "inflammation of many muscles" ('' poly-'' + '' myos-'' + '' -itis''). The inflam ...
, mitochondrial myopathy, etc.). Peripheral nerve is assessed to help work up patients with suspected peripheral neuropathies secondary to such conditions as
vasculitis
Vasculitis is a group of disorders that destroy blood vessels by inflammation. Both arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily caused ...
and
amyloidosis.
Neuropathology is a heavily research-oriented field.
Prominent historical and current figures
Santiago Ramon y Cajal
Santiago (, ; ), also known as Santiago de Chile, is the capital and largest city of Chile as well as one of the largest cities in the Americas. It is the center of Chile's most densely populated region, the Santiago Metropolitan Region, whose ...
is considered one of the founders of modern neuroanatomy.
Alois Alzheimer
Alois Alzheimer ( , , ; 14 June 1864 – 19 December 1915) was a German psychiatrist and neuropathologist and a colleague of Emil Kraepelin. Alzheimer is credited with identifying the first published case of "presenile dementia", which Kraep ...
, the person after whom
Alzheimer's disease
Alzheimer's disease (AD) is a neurodegeneration, neurodegenerative disease that usually starts slowly and progressively worsens. It is the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in short-term me ...
is named, is considered an important early contributor to the field.
There are many neuropathologists around the world who have made important clinical and research contributions toward our understanding of diseases that specifically affect the brain (degenerative diseases, multiple sclerosis, stroke, brain tumors, trauma and neuromuscular diseases). The majority are members of the International Society of Neuropathology (ISN). For neuropathologists practicing within the United States of America please refer to the Membership Directory available through the American Association of Neuropathologists (AANP) website. There are also Membership Directories available for many of the neuropathology societies that exist in other specific countries and/or regions of the world (British, European, Canadian... etc.).
Progress
A European Board Examination in Neuropathology which emphasizes the importance of proper training in the neurosciences is currently being established (www.euro-cns.org). The most recent international congress of neuropathology was held in Tokyo, Japan, in September 2018.
Journals
Academic neuropathology is served by several specialist neuropathology journals.
Acta Neuropathologica
''Acta Neuropathologica'' is a monthly peer-reviewed scientific journal covering all aspects of neuropathology published by Springer Science+Business Media. It was established in 1961 and the editor-in-chief is Johannes Attems ( Newcastle Univers ...
is the neuropathology journal with the highest impact factor.
Some journals are sponsored by national or international neuropathology associations:
Brain Pathology is the official journal of the International Society of Neuropathology,
Neuropathology & Applied Neurobiology is sponsored by the
British Neuropathological Society The British Neuropathological Society is a professional organisation dedicated to the science of neuropathology. It is one of several national societies composed of neuropathologists. These national groups are members of the International Society o ...
, the
Journal of Neuropathology & Experimental Neurology is the official journal of the
American Association of Neuropathologists (AANP) and "Neuropathology" is the official journal of the Japanese Society of Neuropathology.
References
Further reading
* Neuropathology and iron, in
External links
American Association of Neuropathologists
British Neuropathological Society
EuroCNS European Confederation of Neuropathological Societies
International Society of Neuropathology
Blog by neuropathologist Brian E. Moore, MD
Web site by Dimitri Agamanolis, M.D.
wiseGEEK
{{Authority control
Neuropathology,
Anatomical pathology
Neurology