Neuropathology is concerned with pathologic changes of the central and peripheral nervous systems in deceased, as well as living, patients. Biopsies of muscles and nerves are a major procedure in neuropathology, along with cerebrospinal fluid sampling. Within Europe, Germany is the only country where neuropathology forms an independent branch of pathology.
What is neuropathology?
Neuropathology is concerned with pathological changes of the central and peripheral nervous system in deceased, but also living patients. Pathology deals with pathological conditions and changes in the body. Neuropathology is a branch of this medical field. It deals with pathological conditions and changes in neurological tissues. Changes in the central nervous system fall into this field, as do those of the meninges or peripheral nerves. In addition to the cerebral cortex and the cerebellum, the cranial nerve nuclei and the spinal cord also play a role in neuropathology. In Europe, neuropathology is a separate field of pathology only in Germany. A residency in this field qualifies a neuropathologist throughout Germany. Neurology and neurosurgery as well as psychiatry are to be distinguished from neuropathology. While these medical subspecialties are practical subjects, neuropathology is a clinical-theoretical subject. The beginnings of neuropathology date back to the 17th century and an English physician named T. Willis. In the 19th century, neuroscience experienced a heyday and neuropathology solidified itself as a medical specialty.
Treatments and therapies
Like any other pathology, neuropathology studies the origin and mode of development of changes in organic tissues. In the neuropathology subspecialty, this study focuses on neurologic tissue from the central and peripheral nervous systems. This tissue can correspond to nerve tissue, spinal cord tissue or brain tissue. However, muscle tissue may also fall within the scope of the neuropathologist. In addition to the origin and mode of development of the changes, the course and consequences of neurological diseases also play a role in neuropathology. For example, pathological changes of the neurological system may be preceded by a neurological degenerative disease. On the other hand, tumors or immunological processes can also cause changes in the central and peripheral nervous system. In addition to the examination of altered tissue from the living patient, autopsy of deceased patients occupies an important position within neuropathology. The most important part of the neuropathological spectrum of tasks remains research. In the 21st century, neurodegeneration caused by diseases such as Alzheimer’s disease plays a particularly important role with regard to neuropathological research. However, neuroimmunology also occupies an important position in neuropathological research in the context of diseases such as multiple sclerosis. Neurology and neurosurgery in particular draw on the findings of neuropathology. For example, they develop prophylactics, diagnostics, and therapies for various diseases of the nervous system based on neuropathological research findings. The discussion of neuropathological research results and new observations is the order of the day in the theoretical field. As a rule, interdisciplinary discussions with colleagues from practical medical fields take place in particular. Since neuropathology itself is not practical but clinical-theoretical, there is actually no question of a treatment spectrum within the scope of this specialty. Neuropathology undertakes the investigation and clarification of neurological diseases. The actual treatment is taken over by practical fields, such as neurology and neurosurgery. Possibly, psychiatry may also provide treatment. This applies to disorders that are found to be independent of pathologic changes in the neurologic system during neuropathologic examinations.
Diagnosis and examination methods
One of the most important procedures in neuropathology is muscle biopsies. In such a biopsy, the physician removes pathologically altered muscle tissue from the patient and examines the cause of the change in the laboratory. This method is used primarily when muscular diseases are suspected.However, nerve biopsies are also relevant for neuropathology. The removal of nerve tissue from the neurological system is mostly used for the diagnosis of neurodegenerative diseases. In particular, demyelinating diseases can be diagnosed by the procedure. Brain biopsies also take place as part of neuropathology. In this type of tissue sampling, a small hole is usually drilled into the skull bone. Into this hole, the doctor inserts a hollow needle, which is used to remove tissue. Biopsy tissue is examined biochemically and molecularly in the laboratory. In this way, a biopsy allows possible causes of disease to be narrowed down. When sampling and examining tumorous changes in the central and peripheral nervous system, neuropathology overlaps with the field of molecular pathology. This medical field focuses on genomic sequence analysis of tumor cells. In neuropathology, the sampling of neurological tissues can also take place in the course of an autopsy and post-mortem examination. In this context, tissue sampling is primarily used for neuropathological research. Just as important as the collection of muscle, brain and nerve tissue is the collection of cerebrospinal fluid samples for neuropathology. CSF is also known as cerebrospinal fluid and fills the cavities of the brain. From the brain, this cerebrospinal fluid drains into the external CSF spaces. Pathological processes in the central nervous system are reflected in the CSF in increased cell numbers or deviating concentrations of other substances. The cerebrospinal fluid is taken from the lower cerebrospinal fluid space as part of a CSF sample. This CSF space is located in the area of the spinal column and is punctured for sampling. Examination of the collected cerebrospinal fluid has allowed a leap in the diagnosis of various neurological diseases.
