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Neuropathology is the study ofdisease of nervous system tissue, usually in the form of either small surgicalbiopsies or whole-bodyautopsies. Neuropathologists usually work in a department ofanatomic pathology, but work closely with the clinical disciplines ofneurology, andneurosurgery, which often depend on neuropathology for a diagnosis. Neuropathology also relates toforensic pathology because brain disease or brain injury can be related tocause of death. Neuropathology should not be confused withneuropathy, which refers to disorders of the nerves themselves (usually in theperipheral nervous system) 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.
The work of the neuropathologist consists largely of examiningautopsy orbiopsy tissue from thebrain andspinal cord to aid indiagnosis of disease.[1] 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 andMRI scans are also used to discover lesions in the patient. As forautopsies, the work of the neuropathologist is to make post-mortem diagnosis of diseases such asdementia,Parkinson's disease 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.Epidermalnerve 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.
In many English-speaking countries neuropathology is considered a subfield ofanatomical 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, abiopsy ofnervous 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.
Neuropathologists are physicians with aDoctor of Medicine (MD) orDoctor of Osteopathic Medicine (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 theAmerican Board of Pathology[2] 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 aPh.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).
Neuropathologists are medically qualified practitioners who are registered with theGeneral Medical Council in the UK. A postgraduate qualification in neuropathology is obtained through training and an examination overseen by theRoyal 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. 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 aspolymyositis, mitochondrial myopathy, etc.). Peripheral nerve is assessed to help work up patients with suspected peripheral neuropathies secondary to such conditions asvasculitis andamyloidosis.
Neuropathology is a heavily research-oriented field.
Santiago Ramon y Cajal is considered one of the founders of modern neuroanatomy.Alois Alzheimer, the person after whomAlzheimer's disease 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 andneuromuscular 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.).
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.
Academic neuropathology is served by several specialist neuropathology journals.Acta Neuropathologica is the neuropathology journal with the highest impact factor.[3] 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 theBritish Neuropathological Society, theJournal of Neuropathology & Experimental Neurology is the official journal of theAmerican Association of Neuropathologists (AANP) andNeuropathology is the official journal of the Japanese Society of Neuropathology.
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