Brains will be allowed to fix for at least 7 days prior to cutting. You will be assigned brains for cutting the Thursday preceding brain cutting. They will be weighed, examined and cut on Monday mornings before meeting with the attending Neuropathologist. In cases with interesting or relevant external anatomy, they will be cut at the time of meeting with the attending. Gross autopsy findings should be reviewed prior to brain cutting. CT scans and other aids will augment presentation of the cases.

Brains with no anticipated abnormalities where the cause of death has been established at autopsy may be donated for teaching purposes. Donated brains will receive a detailed description of the external gross appearance only.

All other brains will be examined by sectioning and gross diagnosis and a detailed (gross) description of the macroscopic findings dictated that day, along with the cassette summary. After review with the attending, cassettes will be submitted on blocks of defined areas including lesions as well as areas relevant to the history and general autopsy findings.

Consultation with the Neuropathology text prior to brain cutting will indicate pertinent areas to examine. Photographs will be taken as necessary. The resident should review microscopic findings the Thursday after brain cutting. The slides should be reviewed with the attending at the Friday 9:00 signout. Special stains may be suggested by the attending. The final report should be dictated and corrected before being submitted to the attending who examined the microscopic findings.

The following suggestions are intended as a guide for pathology and neurology residents:

1. Weigh brain and record
2. Meninges--thrombus in sagittal sinus, discoloration of dura, thickening or opacity of leptomeninges, lesions
3. External surface--softening, swelling, discoloration, hemorrhage (note subdural, subarachnoid or intraparenchymal), vascular malformations, widening of sulci or flattening of gyri, gyral pattern including olfactory tracts, symmetry or lack of, herniation of cingulate gyrus, uncus and/or cerebellar tonsils or upward herniation of cerebellum, atrophy of pons or medulla including pyramids and olives, cerebellar atrophy including superior vermis.
4. Circle of Willis--describe carefully. Most are NOT "textbook", Draw a picture if necessary; evaluate atherosclerosis, aneurysms or other lesions. Dissect off base of brain in cases of interest
5. Cranial nerves--check for normal anatomy, especially olfactory bulbs in pediatric cases. Look for swelling, tumors or other lesions
6. Spinal Cord--check circulation, anterior and posterior roots, cervical and lumbar swelling, cauda equina for tumors, other lesions
7. Remove brainstem and cerebellum from the cerebral hemispheres by making a transverse cut at high midbrain level
8. Coronally section brain by making 1 cm thick cuts, placing left side on your left
9. Remove brainstem from cerebellum by cutting through cerebellar peduncles. Section brainstem by making transverse cuts at 0.5 cm intervals, again placing left side on your left
10. Section cerebellum sagittally, placing left cerebellum on your left and superior surface upwards on the tray. For very small infant or fetal brains it is sometimes more useful to leave the cerebellum attached to the brainstem and cut either transverse or sagittal sections, depending upon the clinical situation
11. Section spinal cord at 1 cm intervals

Examine brain and cord carefully for lesions. Specifically, check cortex and white matter for infarcts, necrosis, tumor, etc. Examine ventricles for widening or granularity. Inspect caudate and basal ganglia for atrophy. Search for lacunes or vascular abnormalities such as telangiectasis or dural hemorrhages in the brainstem. Look at the pigmented areas including the locus ceruleus and substantia nigra. Examine mammilary bodies for old/new hemorrhage and pons for central myelinolysis. The cerebellum may show abnormalities of the folia if the patient had been on a respirator, or vermal atrophy in alcoholics. Examine cerebellar white matter for atrophy. Record findings carefully, including clear notations on pertinent negative observations (as) relevant to the case. 

Neuropathology Autopsy Procedures on Unusual or Special Cases