Wednesday, March 30, 2011

What's the Diagnosis March 30, 2011

What is this?


  1. it's dual layer microcystic change of the cortex, but i don't know why. i don't think it's related to hypoxia or toxicity. not really focal cortical dysplasia either i believe. a malformation?

  2. I think hypoxia wouldn't be that selective of certain layers.

  3. It is! It's called pseudolaminar necrosis and that's what we have here. There are certain regions of the brain that are more susceptible to hypoxia than others. In adults those regions are CA1 of the hippocampus, the Purkinje cells in the cerebellum, the basal ganglia and layers 3 and 5 (sometimes you'll see layer 6 included in that) of the cortex. These seem to be regions that produce a lot of glutamate, and that may play a role in why it's so selective. Grossly, the cortex will look crumbly, like cookie dough. If you run your finger along the cortical ribbon, you'll see the pieces of cortex flake away. It's just as important to touch the brain as it is to look at it! Here is a link to a cool gross photo of pseudolaminar necrosis.

  4. Thank you!.. I really want to ask about this case, but I didn't have time to do...
    How about his symptoms?
    And are these gross findings on fixed specimen or fresh specimen?
    When did you sample this after death?

  5. The symptoms would be unconsciousness! It doesn't really matter how he presents, this finding is associated with profound lack of perfusion of the brain. Anything that results in such a circumstance will give you this finding. You can see the gross findings in both fresh and fixed. Look for it in areas where you have a loss of the gray-white junction.