Guidelines for brain sampling

Brain sampling

1. (i) Centres should continue current practice regarding which side of the cerebral hemisphere is sampled for histology (e.g. routinely from the right or left hemisphere, or alternatively right then left),

2. (ii) For cerebral hemisphere dissection the recommended coronal plane should be perpendicular to a line joining the inferior frontal and inferior occipital poles.

Neocortical regions

Coronal levels (CL) are indicated – see Fig. 1.

1. (i) Frontal BA8/9 The middle frontal gyrus in the superior frontal sulcus at the plane just rostral to the temporal tip CL8/9

2. (ii) Temporal BA21 The superior sulcal margin (superior temporal sulcus) of the middle temporal gyrus at the plane of the amygdaloid and mammillary body. CL14/15

3. (iii) Parietal BA40 The superior sulcal margin (intraparietal sulcus) of the parietal lobule at the plane lcm caudal to the posterior pole of the splenium. CL24/25

Limbic or paralimbic regions

1. (i) Anterior cingulate BA24 At a plane rostral to the anterior commissure approximately 1.5 cm caudal to the anterior pole of the genu. CLIO/11

2. (ii) Transentorhinal BA29 The sulcal margin (collateral sulcus) of the parahippocampal gyrus at the plane of the red nucleus. CL17/18.

Brain stem regions

The CERAD Neuropathological Assessment sampling protocols are recommended for the substantia nigra, locus coeruleus, and dorsal nucleus of vagus.

Guidelines for evaluation of Lewy body distribution and frequency Cortical Lewy body frequency

Assessment is on a semiquantitative scale. In each region the total number of Lewy bodies (LB) in the designated area are counted in either H&E or ubiquitin-stained sections (cases with concomitant Alzheimer's disease may need additional stains to discriminate Lewy bodies and globose neurofibrillary tangles).