Neuropathology – 02

Author: Murat Gokden, M.D.

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1. 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?

Left meningeal artery rupture

Left cerebral artery rupture

Right meningeal artery rupture

Previously asymptomatic bacterial meningitis

Rupture of an anterior communicating artery aneurysm

2. 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

Metastatic lung cancer secondary to heavy smoking

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

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

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

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

Pituitary apoplexy is a postpartum neurosurgical emergency

Growth hormone adenoma is the most common type

Nelson syndrome is associated with gonadotroph adenomas

Invasive adenomas have high probability of distant metastases

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

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

Neuropathology Set 2 Q6 — Neuropathology Set 2

E. coli is the most common cause in the elderly

cerebrospinal fluid shows increased lymphocytes and normal glucose level

S. pneumoniae is the most common cause in adolescents

it may result in hydrocephalus

it represents diffuse involvement of meninges by malignancy

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

Neuropathology Set 2 Q5 — Neuropathology Set 2

It is the most common cause of subarachnoid hemorrhage

The most common location is posterior cerebral artery branches

It is the second most common type of intracranial aneurysm

bleeding is typically associated with incipient leakage

it is usually located at the bending points of arteries

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

Neuropathology Set 2 Q12 — Neuropathology Set 2

Pericardial cyst

Glioblastoma

Renal cell carcinoma

Cardiac rhabdomyoma

Subungual angioma

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

Neuropathology Set 2 Q8 — Neuropathology Set 2

This disease most commonly involves ageing neurons with lipofucsin pigment

This picture is most likely from caudate nucleus

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

This disease can easily be suspected in neonates by gross examination

Increase in serotonin levels is the major abnormality

8. Which of the following is true regarding neursyphilis?

Tabes dorsalis is the type that leads to dementia

Meningovascular form is associated with obliterative endarteritis of the meninges

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

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

It occurs in the secondary stage of the disease

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

opportunistic infections are more commonly seen in the pediatric patient population

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

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

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

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

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

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

it comprises approximately 1/3 of all intraparenchymal brain hemorrhages

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

11. Duret hemorrhages:

are the most common cause of aqueductal stenosis

accompany cerebellar mass lesions

are seen in midbrain and pons

occur in association with subfalcine herniation

are secondary to middle meningeal artery tears

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

Neuropathology Set 2 Q10 — Neuropathology Set 2

It is associated with an abnormality in 22q

It is associated with an autosomal-recessive disorder

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

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

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

13. Which of the following pairs is correct?

Vitamin B1 deficiency- subacute combined degenration of the spinal cord

Kerns- Sayre syndrome- mitochondrial tRNA

Amyotrophic lateral sclerosis- trinucleotide repeats

Metachromatic leukodystrophy- arylsulfatase A

Adrenoleukodystrophy- long chain fatty acids

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

Neuropathology Set 2 Q14 — Neuropathology Set 2

It is usually seen in the temporal lobe

1p/19q losses indicate worse prognosis

Spinal cord is the most common location in children

GFAP has a peculiar perinuclear positivity

Cerebrospinal fluid dissemination is common

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

It is typically located in the brainstem

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

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

It may be associated with renal cell carcinoma

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