The relevance of the Lewy body to the pathogenesis of idiopathic Parkinson's disease

Accuracy of clinical diagnosis of idiopathic Parkinson's disease

Professor Andrew Lees of the National Hospital for Neurology and Neurosurgery, Queen Square describes the clinico-pathological studies at the Queen Square Brain Bank that have led to improved diagnostic accuracy of Parkinson's syndromes in neurological practice

During my undergraduate training at the London Hospital, Whitechapel, the teaching autopsy was an eagerly anticipated ritual. The whole medical firm would troop across the road from the hospital to the mortuary where a clinician, often the consultant, would present the history and physical signs of the deceased and then the morbid anatomists would reveal the macroscopic pathological findings. Henry Urich perched on a ledge next to the cadaver would, with his exotic Eastern European accent, lead the discussion on all the neurological cases while we remained transfixed looking down in awe from the gallery. The naked eye appearances of the sliced brain allowed him to suspect diagnoses such as Parkinson's disease and exposed other pathologies, such as tumours and haemorrhage. These demonstrations taught me the rudiments of the classical anatomo-clinical neurological method, the great level of uncertainty relating to the cause of death that existed in so many cases, the frequency of multiple pathologies in an individual case and most of all the need for humility. A decade later autopsy rates began to tumble in the UK and the teaching autopsy was on its last legs; but for a few dissenting voices, nobody seemed to care. The opportunities to do …