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3 - Assessment of the brain in the hospital consented autopsy

Published online by Cambridge University Press:  06 January 2010

Nigel Kirkham  and
Neil A. Shepherd
By
William Stewart  and
Susan F.D. Robinson
Nigel Kirkham
Affiliation:
Royal Victoria Infirmary, Newcastle
Neil A. Shepherd
Affiliation:
Gloucestershire Royal Hospital
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Summary

EXAMINATION OF THE BRAIN AT AUTOPSY – AN APPROACH

This chapter considers the pathological changes that may be found in brains examined in non-forensic autopsies, where the pathology falls within the general heading of ‘natural causes’. Following recent organ-retention issues hospital consented autopsy practice has undergone marked change, resulting in a decline in the proportion of hospital deaths that come to autopsy. A recent audit in this hospital showed a fall in the autopsy rate for in-hospital deaths from 7.8% in 1997 to 3.2% in 2001, with a parallel reduction in the number of brains being retained for formal neuropathology examination within the region. In the ‘Guidelines on Autopsy Practice’ (2002) published by The Royal College of Pathologists it is advised that,

‘All major organs (heart, lungs, brain, liver and kidneys) should be dissected in order to facilitate examination of the blood and drainage in addition to relations with adjacent structures. These organs should be separated and weighed. If permitted and clinically relevant, fixation of the intact brain, followed by a detailed examination by a neuropathologist, produces a higher detection rate of abnormalities.’ [1]

Furthermore, it is suggested that occasions where the contents of the cranial cavity are not examined ‘should be exceptional’. This advice is intended to support a full and thorough approach to autopsy practice at the same time as facilitating training in autopsy techniques.

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Progress in Pathology , pp. 49 - 72
Publisher: Cambridge University Press
Print publication year: 2007

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