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14 Headlines Under the Arch: One of New Zealand’s only Neuropathologists Dr Komal Srinivasa MBChB FRCPA PGDip ClinEd Dr Komal Srinivasa is a Consultant Anatomical Pathologist specialising in neuropathology and uropathology at LabPlus at Auckland District Health Board. Pathology is the branch of medicine involved in understanding causes and processes of disease by performing tests on samples taken during surgery or as part of a medical examination. Komal is a graduate of the University of Otago and has worked within the Auckland region as well as Christchurch and Palmerston North. She has undergone post-graduate training at the Western General Infirmary in the UK and the Washington University School of Medicine/Barnes-Jewish Hospital in St Louis, USA. She maintains a keen interest in clinical education and is currently applying to enrol in a doctorate through the University of Auckland. She is an avid runner and is married with two young children. In 2019-2020, I had the privilege of spending almost a year within the Division of Neuropathology at the Washington University School of Medicine (WUSM)/Barnes-Jewish Hospital in St Louis, Missouri, USA. This was made possible in part by the generous financial support provided to me by the Neurological Foundation. WUSM is a top-tier academic institution and was recently ranked as one of the top ten medical schools in the USA. Barnes-Jewish Hospital, its clinical partner organisation, has been rated as one of the top 10 hospitals in the USA and serves several million people from across the USA. Both institutions have developed an international reputation in the treatment of neurological diseases and my time with them was an invaluable learning experience. As a trainee a decade ago, I expressed an interest in neuropathology as it remained a mystery due to the complex nature of the cases. In my medical training, I had seen the devastating impact of neurological diseases, cancerous and degenerative, and the limited understanding we possessed as a medical community. At the same time, the integration of molecular medicine and other advances meant that patients with previously only a few months to live suddenly had a better tool for prognostication and more treatment options. After commencing specialist practice, I remained committed to devoting a portion of my practice to neuropathology. My formal position at WUSM was of a researcher and clinical observer and this provided me considerable latitude to be academically productive and obtain clinical immersion in the sheer volume of cases seen. My background to this point had included specialist practice in Anatomical Pathology with a focus on neuropathology at LabPLUS at Auckland District Health Board. Prior to my time in St Louis, I had spent the previous year at the Western General Hospital and the University of Edinburgh in the UK obtaining further experience in neuropathology including learning from Professor Colin Smith, one of the preeminent national experts and Head of the UK’s National Creutzfeldt-Jakob Disease Research and Surveillance Unit (NCJDRSU). As a result, I was ideally placed to take advantage of the opportunities at WUSM and was also able to contribute a global perspective to their practice. Clinical exposure: The division of neuropathology at WUSM was extremely busy with a daily influx of cases and requirements for reporting specimens ‘in real time’ whilst patients were undergoing surgery (Frozen Sections). I was thus able to gain significant exposure to brain cancers and neurodegenerative diseases such as Parkinson’s disease. This was supplemented by formal didactic weekly teaching on these topics. A weekly tumour board meeting had a mixture of complex malignant and benign entities where the radiology, surgical and pathological findings were discussed, as well as the patients’ prognosis and treatment options. It was illuminating to hear about the new and exciting treatment options that are available in the USA (such as new drugs like Avastin, that can block the blood supply to cancers thus starving them and reducing their ability to grow) and the different clinical trials patients, including overseas patients, can get enrolled into. I was also fortunate to work with and learn from some inspiring individuals. Professor Robert Schmidt, the chair of the Neuropathology Department, has been a practising neuropathologist for over four decades and is currently compiling a definitive text on the subject of neuropathology. As with most professional occupations, he was the embodiment of the phrase - “there’s no substitute for experience” - and learning from him about the nuances of neuropathology will remain a lifelong professional highlight. The USA’s Alzheimer’s Disease Research Centre (ADRC) is a nationally