The continuous monitoring of bovine spongiform encephalopathy (BSE) cases is an integral component of European research and surveillance programmes, to ensure that any changes in the presentation of transmissible spongiform encephalopathies (TSE) in cattle can be detected and defined. Monitoring is generally limited to the brainstem at the level of the obex, for reasons of practicality, safety and cost. Demonstration of disease-specific prion protein (PrP(d)) by immunohistochemistry is currently the most widely used confirmatory tool for both active and passive surveillance. This study assessed PrP(d) immunostaining in the brainstems (obex) of cattle with BSE in the UK and Italy. Immunoreactivity 'profiles' were created for each case based on the nature of the immunostaining, its relative intensity and precise neuroanatomical location. This study compares the obex immunostaining patterns of Italian cases (only active surveillance) and two UK groups (both active and passive surveillance). The neuroanatomical distribution and relative intensity of PrP(d) was highly reproducible in all cases. The overall staining intensity varied widely but was generally stronger in the active than in the passive surveillance populations. The conclusion to be drawn from this comparative study is that the pattern of immunopathology in these routine screening samples for BSE diagnosis and surveillance is the same in the UK and Italy, whether or not the animal was displaying typical, or indeed any, clinical signs at the time of sampling. This indicates that the current confirmatory diagnostic strategy remains appropriate for active surveillance applications.