This blog will discuss anything related to the practice of forensic pathology. Topics will including recent articles in the medical literature, interesting cases in the news, TV forensics, and the general day to day things I have to deal with as a forensic pathologist. If there is something you want to know or have an idea for a topic, drop me a line. I am going to try and spend some time on histopathology with the hope of getting fellows ready for the boards!
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?
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. http://library.med.utah.edu/WebPath/CNSHTML/CNS112.html
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?
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.
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?
ReplyDeleteAll good thoughts. Why not hypoxia?
ReplyDeleteI think hypoxia wouldn't be that selective of certain layers.
ReplyDeleteIt 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.
ReplyDeletehttp://library.med.utah.edu/WebPath/CNSHTML/CNS112.html
Interesting, thanks!
ReplyDeleteThank you!.. I really want to ask about this case, but I didn't have time to do...
ReplyDeleteHow about his symptoms?
And are these gross findings on fixed specimen or fresh specimen?
When did you sample this after death?
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.
ReplyDelete