Neuropathology – 02

Author: Murat Gokden, M.D.

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1. Which of the following is correct regarding hypertensive central nervous system hemorrhage?

periventricular white matter is the preferred site for hemorrhage

many cases are associated with congophilic angiopathy

it is the second most common cause of subdural hemorrhage

it comprises approximately 1/3 of all intraparenchymal brain hemorrhages

Charcot-Bouchard aneurysms are thought to be the site of hemorrhage

2. Which of the following is true regarding pituitary adenomas?

Nelson syndrome is associated with gonadotroph adenomas

Pituitary apoplexy is a postpartum neurosurgical emergency

Invasive adenomas have high probability of distant metastases

Growth hormone adenoma is the most common type

Reticulin stain is a very useful technique for the differential diagnosis of normal pituitary gland vs. hyperplasia vs. adenoma

3. Which of the following lesions may be found together with the lesion shown in the picture? (SEGCA)

Neuropathology Set 2 Q12 — Neuropathology Set 2

Cardiac rhabdomyoma

Subungual angioma

Renal cell carcinoma

Glioblastoma

Pericardial cyst

4. Which of the following is true regarding neursyphilis?

Tabes dorsalis is the type that leads to dementia

Neurosyphilis occurs in approximately half of untreated and 10% of treated patients

Meningovascular form is associated with obliterative endarteritis of the meninges

It occurs in the secondary stage of the disease

Paretic neurosyphilis is aseptic and is an immune reaction to bacterial components

5. Which of the following is true regarding the lesion in this picture?

It may be associated with renal cell carcinoma

It is a highly malignant brain tumor with frequent dissemination to cerbrospinal axis

It usually presents as a highly infiltrative tumor, but paradoxically has a good prognosis

It is typically located in the brainstem

Its immunophenotype is essentially identical to renal cell carcinoma in many cases

6. Which of the following pairs is correct?

Kerns- Sayre syndrome- mitochondrial tRNA

Vitamin B1 deficiency- subacute combined degenration of the spinal cord

Adrenoleukodystrophy- long chain fatty acids

Metachromatic leukodystrophy- arylsulfatase A

Amyotrophic lateral sclerosis- trinucleotide repeats

7. A 29 year old man was found dead in the street. Autopsy showed hemorrhage under occipital scalp, and contusions of both occipital poles. Which of the following is the most likely explanation?

Intracranial hemorrhage secondary to hypertension

He was previously strangled to death and later the body was dumped in a remote street, at which time his head his the concrete pavement

Slipped and fell on his back, hitting his head to concrete pavement

Metastatic lung cancer secondary to heavy smoking

He was attacked and was hit on the back of his head by a baseball bat

8. Which of the following is correct regarding the lesion shown in this picture?

Neuropathology Set 2 Q5 — Neuropathology Set 2

The most common location is posterior cerebral artery branches

bleeding is typically associated with incipient leakage

It is the most common cause of subarachnoid hemorrhage

It is the second most common type of intracranial aneurysm

it is usually located at the bending points of arteries

9. Which of the following is true regarding the lesion shown in the picture?

Neuropathology Set 2 Q10 — Neuropathology Set 2

It is associated with one of the rarest form of genetic disorders

It is associated with an autosomal-recessive disorder

It is associated with an abnormality in 22q

Bilateral schwannomas are also present in volving the 8th. nerve

It has a higher rate of progression to malignancy compared to general population

10. While walking home after a party where he consumed five cans of beer, a previously healthy 28 year-old man fell and hit his head on the curb. He got up and went home. Later that night, he became unconscious and was brought to the emergency room by his roommate. Physical exam showed swelling of left temporalparietal area. What is the most likely explanation to his condition?

Right meningeal artery rupture

Rupture of an anterior communicating artery aneurysm

Previously asymptomatic bacterial meningitis

Left meningeal artery rupture

Left cerebral artery rupture

11. Which of the following is true regarding the lesion shown in the picture?

Neuropathology Set 2 Q14 — Neuropathology Set 2

Spinal cord is the most common location in children

GFAP has a peculiar perinuclear positivity

Cerebrospinal fluid dissemination is common

It is usually seen in the temporal lobe

1p/19q losses indicate worse prognosis

12. Which of the following is true regarding the disease shown in the picture?

Neuropathology Set 2 Q6 — Neuropathology Set 2

S. pneumoniae is the most common cause in adolescents

it represents diffuse involvement of meninges by malignancy

it may result in hydrocephalus

E. coli is the most common cause in the elderly

cerebrospinal fluid shows increased lymphocytes and normal glucose level

13. Duret hemorrhages:

occur in association with subfalcine herniation

are seen in midbrain and pons

are the most common cause of aqueductal stenosis

are secondary to middle meningeal artery tears

accompany cerebellar mass lesions

14. Which of the following is true regarding the disease process shown in the picture?

Neuropathology Set 2 Q8 — Neuropathology Set 2

Structures with similar name, but with different microscopic appearance can be seen in cortical neurons and are easily demonstrated by synuclein immunohistochemistry

This disease most commonly involves ageing neurons with lipofucsin pigment

Increase in serotonin levels is the major abnormality

This picture is most likely from caudate nucleus

This disease can easily be suspected in neonates by gross examination

15. Which of the following is correct regarding HIV and central nervous system?

CJD caused by opportunistic JC virus infection is a rare but serious complication

diagnostic feature is intense lymphocytic infiltrates in the brain parenchyma and in the leptomeninges

spinal cord involvement presents as transverse myelitis due to opportunistic Herpes virus infection

opportunistic infections are more commonly seen in the pediatric patient population

approximately 60% of AIDS patients develop neurologic dysfuntion in the course of their disease

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