Neuropathology is the study of

disease A disease is a particular abnormal condition that adversely affects the structure or function (biology), function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical condi ...

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, but work closely with the clinical disciplines of

neurology Neurology (from , "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 conditions and disease involving the nervous syst ...

, and

neurosurgery Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the specialty (medicine), medical specialty that focuses on the surgical treatment or rehabilitation of disorders which affect any portion of the nervous system ...

, 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 ...

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 the 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. In rare cases, an ...

. Neuropathology should not be confused with

neuropathy Peripheral neuropathy, often shortened to neuropathy, refers to damage or disease affecting the nerves. Damage to nerves may impair sensation, movement, gland function, and/or organ function depending on which nerve fibers are affected. Neuropa ...

, 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 Bilateria, bilateral animals, with the other part being the central nervous system (CNS). The PNS consists of nerves and ganglia, which lie outside t ...

) 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 (also referred to as 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 deat ...

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, an interventional radiologist, or an interventional cardiology, interventional cardiologist. The process involves the extraction of sampling (medicine), sample ...

tissue from the

brain The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...

and

spinal cord The spinal cord is a long, thin, tubular structure made up of nervous tissue that extends from the medulla oblongata in the lower brainstem to the lumbar region of the vertebral column (backbone) of vertebrate animals. The center of the spinal c ...

to aid in

diagnosis Diagnosis (: diagnoses) is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in a lot of different academic discipline, disciplines, with variations in the use of logic, analytics, and experience, to determine " ...

of disease. In addition to brain and spinal cord, tissues of the eyes, nerves, muscles, and tumors are examined. A 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 and

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...

scans are also used to discover lesions in the patient. As for autopsies, the work of the neuropathologist is to make post-mortem diagnosis of diseases such as

dementia Dementia is a syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform activities of daily living, everyday activities. This typically invo ...

Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a neurodegenerative disease primarily of the central nervous system, affecting both motor system, motor and non-motor systems. Symptoms typically develop gradually and non-motor issues become ...

and other conditions that affect the central nervous system. Tissue samples are researched within the lab for diagnosis, and in forensic investigations to clarify the cause of death. Biopsies can also consist of the skin. Epidermal

nerve fiber An axon (from Greek ἄξων ''áxōn'', axis) or nerve fiber (or nerve fibre: see spelling differences) is a long, slender projection of a nerve cell, or neuron, in vertebrates, that typically conducts electrical impulses known as action pot ...

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. 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

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 A Doctor of Medicine (abbreviated MD, from the Latin language, Latin ) is a medical degree, the meaning of which varies between different jurisdictions. In the United States, and some other countries, the ''MD'' denotes a professional degree of ph ...

(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 li ...

(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 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. 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 physician, medical practitioners within the United Kingdom. Its chief responsibility is to "protect, promote and maintain the health and safety of the pu ...

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 p ...

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, 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 artery, arteries and veins are affected. Lymphangitis (inflammation of lymphatic vessels) is sometimes considered a type of vasculitis. Vasculitis is primarily c ...

and amyloidosis. Neuropathology is a heavily research-oriented field.

Prominent historical and current figures

Santiago Ramon y Cajal is considered one of the founders of modern neuroanatomy. Alois Alzheimer, the person after whom

Alzheimer's disease Alzheimer's disease (AD) is a neurodegenerative disease and the cause of 60–70% of cases of dementia. The most common early symptom is difficulty in remembering recent events. As the disease advances, symptoms can include problems wit ...

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 Multiple sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit ...

stroke Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...

, 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 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 & 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

External links

American Association of NeuropathologistsBritish Neuropathological SocietyEuroCNS European Confederation of Neuropathological SocietiesInternational Society of NeuropathologyNeuropathology web site by Dimitri Agamanolis, M.D.
{{Authority control Anatomical pathology Neurology