Neuropathology is the study of disease 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, and neurosurgery, which often depend on neuropathology for a diagnosis. Neuropathology also relates to forensic pathology because brain disease or brain injury can be related to cause of death. Neuropathology should not be confused with neuropathy, which refers to disorders of the nerves themselves (usually in the peripheral 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.
Methodology
The work of the neuropathologist consists largely of examining autopsy or biopsy tissue from the brain and spinal cord to aid in diagnosis of disease. Tissues are also observed through the eyes, muscles, surfaces of organs, and tumors. The 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 scans are also used to discover issues in the patient. 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. Tissue samples are researched within the lab for diagnosis as well as forensic investigations.
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.
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 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.
In the US system
Neuropathologists are physicians with a Doctor of Medicine (MD) or Doctor 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 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).