Page updated 9 October 2007
7.0. Diagnostic Tonsillar Biopsy for Suspected Variant CJD
A tonsil biopsy may be considered in an individual with the following symptoms either in combination or in isolation:
Psychiatric symptoms
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Progressive cognitive impairment
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Ataxia or pyramidal signs
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Unexplained sensory symptoms (e.g. limb pain or dysaesthesiae)
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Unexplained movement disorder
Forward planning is of great importance.
When a patient arrives in hospital for such a biopsy, all the agencies involved with have been warned to expect the case.
The National Prion Clinic physician will decide whether it is necessary to do a tonsillar biopsy. The NHNN Prion Clinical Nurse Specialist will then make arrangements for admission and liaise with the Consultant ENT sugeon and Consultant Neuro-Pathologist. The date for the procedure will be organised with the Theatre Manager.
Admission will be for two nights around the biopsy. Patients will be admitted by the neurology SpR and Prion Clinical Fellow, and the ENT SpR informed when the patient arrives.
- Routine pre-operative blood samples
- Research blood
- Urine samples
and tell the tissue biopsy group of the approximate time of the procedure.
In Theatre
- Biopsies are to be placed in a dry pot with no formalin.
- Label pot with the patient's name and "High Risk" and double bag.
- Neuropathology Research Support Scientist will collect the specimen personally.
- The specimen will be processed in the National Prion Unit under the supervision of Prof Brandner and Dr. Wadsworth.
Post-operative Care
- Hand over care to appropriate SHO on-call for post-operative management (analgesia, fluids, etc).
- Monitor clinically for pain, difficulty breathing or swallowing.
- Nursing staff to maintain proper observations.
- Normally the patient will be ready for discharge on the day after biopsy.
- Plan obtaining and communicating the result of the biopsy (Prion Clinical Fellow)
- Results will be collated and reported by the clinicians in the NPU to the consultant in charge of the case and to the co-ordinator of the CJD Working Group.
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