Imagine the brain
March 21, 2014 Leave a comment
Imagine the brain, that shiny mound of being, that mouse-gray parliament of cells, that dream factory, that petit tyrant inside a ball of bone, that huddle of neurons calling all the plays, that little everywhere, that fickle pleasuredome, that wrinkled wardrobe of selves stuffed into the skull like too many clothes into a gym bag. – Diane Ackerman (‘An Alchemy of Mind. The Marvel and Mystery of the Brain‘, Simon & Schuster, 2004).
Writing a book where each specimen represents a person’s humanity was a challenge, and being a neuropathologist may not be everyone’s cup of tea. However for me examination of the brain and spinal cord is key to the understanding of disease and each patient has provided a legacy that will benefit future generations.
For example, in the past no one could understand why patients suffering road traffic accidents were in coma, but there was nothing to see on their head scans.
Careful examination of the brain by neuropathologists revealed that the rotational injury suffered in many car accidents actually shears the axons- the main transport system of the nerve cells so stopping their function- (so-called diffuse traumatic axonal injury).
And from this observation and others, a number of clinical measures including cooling the brain to slow metabolism and the secondary effects of traumatic head injury are now routine clinical practice.
Similarly there are cases of infections such as meningitis, which have not been diagnosed during life, which can be seen in the brain- that have implications for living contacts. And variant Creutzfeldt-Jakob disease (so-called mad cow disease) was discovered entirely by examining the brain in the diseased. The variant CJD form is now virtually unheard of in the UK, although sporadic- or by chance cases still occur.
I guess for me, though, although sometimes upsetting, some of the most rewarding cases are infant brains where playing a part in the diagnosis of a developmental or inherited disorder- such as a mitochondrial or metabolic disorder has implications for whole families and can give some kind of comfort to grieving mothers.
Every case is a mystery and a marvel and a privilege I never underestimate.
Kathreena M. Kurian is co-author of ‘Atlas of Gross Neuropathology: A Practical Approach‘ (2014).