Neuropathology

Neuropathology is the study of disease of nervous system tissue, usually in the form of either small surgical biopsies or whole autopsy brains. Neuropathology is a subspecialty of anatomic pathology, neurology, and neurosurgery. It should not be confused with neuropathy, which refers to disorders of the nerves (usually in the peripheral nervous system).

Methodology
The work of the neuropathologist consists largely of examining biopsy tissue from the brain and spinal cord to aid in diagnosis of disease. The biopsy is usually requested after a mass is detected by radiologic imaging. 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.

Biopsies can also consist of the skin. Epidermal 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.

Focus of specialization
In many English speaking countries neuropathology is considered a subfield of anatomical pathology. 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 of nervous tissue 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.

Neuropathology in the US System

Neuropathologists are physicians with either MD or DO medical school degrees. They must finish either 2 or 3 years of an anatomical pathology residency followed by 2 years of a neuropathology fellowship and be certified by the American Board of Pathology in both anatomical and neuropathology. It is also quite common for neuropathologists to have PhDs in a related field.

Neuropathology in the UK System

Neuropathologists are medically qualified practitioners who are registered with the General Medical Council in the UK. A postgraduate qualification in neuropathology is obtained through training and an examination overseen by the Royal College of Pathologists UK. A neuropathologist has training in anatomic pathology followed by training in relation to diagnosis of diseases of the nervous system and muscle. A specialist examination (called Part2) in neuropathology is run by the Royal College of Pathologists UK.It is also 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, mitochondrial myopathy, etc.). Peripheral nerve is assessed to help work up patients with suspected peripheral neuropathies secondary to such conditions as vasculitis and amyloidosis.

Neuropathology is a heavily research oriented field.

Prominent historical figures in neuropathology
Santiago Ramon y Cajal is considered one of the founders of modern neuroanatomy. Alois Alzheimer, the person after whom Alzheimer's disease is named, is considered an important early contributor to the field.

A sampling of prominent currently practicing neuropathologists
Among prominent currently practicing neuropathologists are Drs. Dennis W. Dickson (Mayo Clinic), Mark Cohen (Case Western Reserve University), Richard Prayson (Cleveland Clinic), Douglas C. Miller (University of Missouri; until recently at NYU), John Trojanowski (University of Pennsylvania), and John Donahue (Brown University). Dr. Donahue also happens to be a neurologist. Neuropathologists who are also neurologists used to be the norm, but now they are becoming a rare entity.

Stephen J. Nelson, M.D., of Florida, was the neuropathologist who examined Terri Schiavo at autopsy when she died in Pinellas County, Florida. Dr. Nelson also examined Anna Nicole Smith when she died in Broward County, Florida. Dr. Nelson holds the unusual combination of certification in anatomic pathology, forensic pathology, and neuropathology, all by The American Board of Pathology.

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 meeting of neuropathologists occurred in September 2006 in San Francisco, California, USA.

Neuropathology journals
Academic neuropathology is served by several specialist neuropathology journals. Acta Neuropathologica 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 Journal of Neuropathology and 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.