“…3,6,7,15,30,33,36,42,50,55,58,60,63,68,70 Based initially on spongiform changes and examination of large case numbers, the invariable predominance of lesions in the brainstem established this and, specifically, the medulla oblongata as the predilection brain region for diagnostic sampling. 18,30,53,63,66,68,70 Correlation of the highest concentrations of PrP Sc in the brainstem with the greatest degree of spongiform change 30,43,51,68 is considered suggestive of the initial brain pathologic alternations in BSE occurring in this region, consistent with the proposed pathogenesis of transmissible spongiform encephalopathy (TSE) in ruminants and laboratory rodent models after oral exposure. 4,5,13,20,26,29,39,40,61 This is supported by observations in a subset of clinical cases with restricted PrP Sc accumulation, which was invariably confined to the brainstem.…”