The Department of Clinical Neuropathology has wide-ranging connections with hospitals and scientific institutions in the UK and abroad, and is one of the busiest departments of its type in the country. Our close association with King’s College London Medical School and our function as a diagnostic referral centre puts us in a unique position to provide a high-quality, wide-ranging diagnostic service and to carry out research into disease of the nervous system.
We offer teaching and training to a wide range of specialities including trainees in histopathology and forensic pathology. There are regular lectures to undergraduates and postgraduates at King’s College.
We also run the MRC London Brain Bank for Neurodegenerative Diseases, under the directorship of the Head of Department, Dr S Al-Sarraj.
DGH consultants can refer to this service but our services cannot be booked by GPs.
The department receives around 600 brain biopsies annually, most of which are from tumours. We provide an intra-operative (smear and frozen section diagnosis) provisional report within 24 hours and, in most cases, a complete diagnosis with immunohistochemical stains in 48 hours.
We have developed vast experience in diagnosis of brain tumours using modern facilities and classification. We participate in organising multi-disciplinary meetings with paediatric and adult neuro-oncology, neuro-radiology and neurosurgery and pituitary services.
We receive around 300 CSF samples for cytology each year. Samples need to be sent as soon as possible after being taken.
The department receives more than 250 muscle and around 40 nerve biopsies each year, and serves as the main referral centre for muscle and nerve diseases. We use comprehensive immuno-stains for inflammatory myopathy and sarcolemmal protein for muscular dystrophy. A panel of immunohistochemistry, semi-thin sections and electron microscopy is used to investigate the nerve biopsies. There are regular weekly meetings with neurologists and neurophysiologists to discuss cases. See our protocol for sending muscle and nerve biopsies to the department.
We receive around 20 specimens a year from surgery for epilepsy. There is close association between neurophysiologist surgeons, radiologists and neuroradiologists through multi-disciplinary meetings and research projects.
We provide analysis of intraepithelial nerve fibre density (IENFD) using 3mm punch skin biopsies. The technique provides a highly sensitive and specific tool for the diagnosis of a common subtype of neuropathy called small fibre neuropathy. There are regular meetings with neurologists to discuss the cases. See our protocol for sending skin biopsies to the department.
The department provides clinical diagnosis for the MRC London Neurodegenerative Diseases Brain Bank, Institute of Psychiatry.
We receive about 80 donated brains every year. There are regular CPCs and brain cut demonstrations and comprehensive studies of neurodegenerative diseases. The neuropathologists contribute in studies and investigation in many research projects in the neuro-degeneration field, including motor neurone disease and fronto-temporal dementia.
We have an excellent knowledge and experience in neurologically related autopsy examinations (including the diagnosis of Creutzfeldt-Jakob disease) and in forensic neuropathology, particularly for head injury. Our services are offered to HM Coroners and forensic pathologists in the South East and Midlands. The department also co-ordinates research projects and teaching courses in traumatic neuropathology.
Post-mortems may be performed on request and are reported in three parts – a full autopsy report, a macroscopic brain description report and a full microscopy report, where applicable.
Appropriate consent must be obtained to meet all legal requirements before any investigations can be carried out (to reach a diagnosis) and for any retention of tissues (including the brain) for research, teaching and training. It is at the pathologist’s discretion whether they proceed with the autopsy taking into account the level of consent available.