Crack the Case: Seizures, Fever, and a Fatal Outcome

Neuropathology for Neurologists

James W. Mandell, MD, PhD

Disclosures

September 09, 2013

Interpreting the Hippocampal Section

At first glance, the stain shown in Figure 1 could pass for normal hippocampal histology, but not on closer scrutiny. It is possible that some acute ischemic changes might take place as a result of the terminal events, with brain herniation and constriction of cerebral vasculature. However, neuronal eosinophilia is not obvious in this image (although neuropathologists always reserve the right to point to a slightly red neuron and emphatically state that acute ischemia is present).

Shown in the yellow circles, and in a magnified image in the box at lower right, are pyramidal neurons with 1 or more intracytoplasmic eosinophilic (red-staining) inclusions (Figure 2). There is no obvious spongiform degeneration (vacuolization), and the patient's rapid deterioration would not fit with prion disease.

Figure 2. Same hematoxylin/eosin stain as in Figure 1, showing pyramidal neurons and intracytoplasmic eosinophilic inclusions within yellow circles and the magnified image. Image courtesy of James W. Mandell, MD, PhD

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