Neuropathology

Neuropathology US Medical PG Question 1: A 73-year-old man is brought in by his wife with a history of progressive personality changes. The patient’s wife says that, over the past 3 years, he has become increasingly aggressive and easily agitated, which is extremely out of character for him. His wife also says that he has had several episodes of urinary incontinence in the past month. He has no significant past medical history. The patient denies any history of smoking, alcohol use, or recreational drug use. The patient is afebrile, and his vital signs are within normal limits. A physical examination is unremarkable. The patient takes the mini-mental status examination (MMSE) and scores 28/30. A T2 magnetic resonance image (MRI) of the head is performed and the results are shown in the exhibit (see image). Which of the following is the next best diagnostic step in the management of this patient?

• A. Contrast MRI of the head
• B. Lumbar puncture (Correct Answer)
• C. Noncontrast CT of the head
• D. Brain biopsy
• E. Serum ceruloplasmin level

Neuropathology Explanation: ***Lumbar puncture*** - The MRI shows **ventriculomegaly** with **transependymal CSF flow**, indicating **normal pressure hydrocephalus (NPH)**. A high-volume lumbar puncture serves as both a diagnostic and therapeutic test for NPH, as improvement in symptoms after CSF removal (typically 30-50 mL) strongly supports the diagnosis. - This patient presents with **progressive cognitive decline** (personality changes, aggression, agitation) and **urinary incontinence**, two components of the classic NPH triad. While gait disturbance is the third component and most common presenting feature, NPH can present with incomplete triads, and the imaging findings strongly support this diagnosis. *Contrast MRI of the head* - Contrast-enhanced MRI is used to visualize specific lesions such as **tumors, infections, or inflammatory processes**, which are not suggested by this patient's presentation. - The T2 MRI has already demonstrated findings consistent with NPH (ventriculomegaly with transependymal flow), making additional contrast imaging unnecessary for diagnosis at this stage. *Noncontrast CT of the head* - While noncontrast CT can demonstrate ventriculomegaly, **MRI provides superior resolution** for evaluating brain parenchyma and detecting **transependymal CSF flow**, a key indicator of NPH. - Since MRI has already been performed and revealed findings diagnostic of NPH, repeating imaging with a less detailed modality would not add diagnostic value. *Brain biopsy* - Brain biopsy is an **invasive procedure** reserved for cases where **neoplastic, infectious, or demyelinating** conditions are strongly suspected and cannot be diagnosed by less invasive means. - There is no indication of a mass lesion, infection, or focal abnormality requiring tissue diagnosis in this patient's clinical presentation or imaging findings. *Serum ceruloplasmin level* - Serum ceruloplasmin is used to diagnose **Wilson's disease**, a rare genetic disorder of copper metabolism presenting with neuropsychiatric symptoms and movement disorders, typically in patients **under 40 years of age**. - Given this patient's age (73 years) and clear radiological evidence of NPH, Wilson's disease is not a consideration in the differential diagnosis.

Neuropathology US Medical PG Question 2: A group of neurologists develop a new blood test for Alzheimer's. They are optimistic about the test, as they have found that for any given patient, the test repeatedly produces very similar results. However, they find that the new test results are not necessarily consistent with the gold standard of diagnosis. How would this new test most accurately be described?

• A. Valid and reliable
• B. Reliable (Correct Answer)
• C. Valid
• D. Biased
• E. Neither valid nor reliable

Neuropathology Explanation: ***Reliable*** - The test produces **similar results repeatedly** upon repeated measures, indicating high **reliability** or **precision**. - Reliability refers to the **consistency** of a measure, even if it is not accurate. *Valid and reliable* - While the test is **reliable**, it is explicitly stated that the results are **not consistent with the gold standard**, meaning it lacks **validity**. - A test must be both **consistent** (reliable) and **accurate** (valid) to be described as valid and reliable. *Valid* - **Validity** refers to the **accuracy** of a test, or how well it measures what it is supposed to measure. - The test is explicitly stated to **not be consistent with the gold standard**, indicating a lack of agreement with the true measure of Alzheimer's. *Biased* - **Bias** refers to a **systematic error** in measurement that can lead to consistently high or low results compared to the true value. - While the test might be biased due to its lack of consistency with the gold standard, "biased" is not the most accurate single descriptor of its measurement properties given the information provided. *Neither valid nor reliable* - The test is described as producing **very similar results repeatedly**, which directly indicates it has **high reliability**. - Therefore, stating it is neither valid nor reliable is incorrect, as it possesses reliability.

Neuropathology US Medical PG Question 3: A 72-year-old man is brought to the physician by his wife for memory issues over the last 7 months. The patient's wife feels that he has gradually become more forgetful. He commonly misplaces his car keys and forgets his children's names. He seems to have forgotten how to make dinner and sometimes serves uncooked noodles or raw meat. One night he parked his car in a neighbor's bushes and was found wandering the street. He has a history of hypertension, hyperlipidemia, and COPD. Current medications include atorvastatin, metoprolol, ipratropium, and fluticasone. Vital signs are within normal limits. He is alert and oriented to person and place only. Neurologic examination shows no focal findings. His Mini-Mental State Examination score is 19/30. A complete blood count and serum concentrations of electrolytes, urea nitrogen, creatinine, thyroid-stimulating hormone, liver function tests, vitamin B12 (cobalamin), and folate are within the reference range. Which of the following is the most appropriate next step in diagnosis?

• A. Electroencephalography
• B. PET scan
• C. MRI of the brain (Correct Answer)
• D. Lumbar puncture
• E. Neuropsychologic testing

Neuropathology Explanation: ***MRI of the brain*** - An **MRI of the brain** is crucial for evaluating **structural causes of cognitive impairment**, such as tumors, strokes, hydrocephalus, or significant atrophy that might explain the patient's rapidly progressing memory loss and functional decline. - Given the patient's age, rapidly worsening dementia symptoms, and normal initial lab work, imaging is essential to rule out **reversible or treatable causes** and to characterize the extent of neurodegeneration. *Electroencephalography* - **EEG** is primarily used to detect **seizure activity** or to evaluate for rapidly progressive encephalopathies like Creutzfeldt-Jakob disease, which is not indicated by the patient's presentation. - The patient's symptoms are consistent with a dementia syndrome, not acute encephalopathy or seizures. *PET scan* - A **PET scan** (e.g., FDG-PET or amyloid-PET) can provide information about metabolic activity or amyloid plaques, useful for **differentiating types of dementia** (e.g., Alzheimer's disease). - However, it is an advanced test typically considered after structural imaging has ruled out other causes and when the diagnosis remains unclear. *Lumbar puncture* - **Lumbar puncture** is performed to analyze **cerebrospinal fluid (CSF)** for biomarkers (e.g., tau, Aβ42 levels) to help diagnose specific neurodegenerative diseases like Alzheimer's or to rule out infectious/inflammatory causes. - It's usually reserved for cases where other investigations are inconclusive or specific conditions are strongly suspected, and structural imaging has been performed. *Neuropsychologic testing* - **Neuropsychologic testing** provides a detailed assessment of various cognitive domains and can help to **characterize the pattern and severity of cognitive impairment**. - While valuable, it is usually performed after initial medical workup and structural imaging to understand the functional impact of any identified brain changes or to further delineate the type of cognitive disorder.

Neuropathology US Medical PG Question 4: A 57-year-old man is brought to the emergency department by his wife 20 minutes after having had a seizure. He has had recurrent headaches and dizziness for the past 2 weeks. An MRI of the brain shows multiple, round, well-demarcated lesions in the brain parenchyma at the junction between gray and white matter. This patient's brain lesions are most likely comprised of cells that originate from which of the following organs?

• A. Kidney
• B. Skin
• C. Lung (Correct Answer)
• D. Thyroid
• E. Prostate

Neuropathology Explanation: ***Lung (Correct Answer)*** - **Lung cancer** is the most common cause of **brain metastases** in adults, accounting for approximately **50% of all cases** - The clinical presentation—seizure, headaches, dizziness, and **multiple, round, well-demarcated lesions at the gray-white matter junction**—is classic for metastatic lung cancer - Both **small cell and non-small cell lung cancers** have high propensity for hematogenous spread to the brain - The watershed areas at the gray-white junction are common sites due to lodging of tumor emboli in terminal arterioles *Kidney (Incorrect)* - **Renal cell carcinoma (RCC)** can metastasize to the brain but accounts for only **5-10% of brain metastases** - While RCC metastases can appear similar on imaging, lung cancer is statistically more likely given its higher prevalence - RCC metastases are often **highly vascular and may hemorrhage**, which is not mentioned in this case *Skin (Incorrect)* - **Melanoma** has the **highest propensity per case** to metastasize to the brain among all cancers - However, the **overall incidence of melanoma is much lower** than lung cancer, making it a less probable primary source - Melanoma brain metastases often present as **hemorrhagic lesions** and would typically have skin findings or history *Thyroid (Incorrect)* - **Thyroid cancer** rarely metastasizes to the brain (accounts for <1% of brain metastases) - Brain metastases from thyroid cancer typically occur in **advanced papillary or follicular carcinoma** or in **anaplastic thyroid cancer** - More common metastatic sites for thyroid cancer are lung and bone *Prostate (Incorrect)* - **Prostate cancer very rarely metastasizes to the brain** (<1% of cases) - Prostate cancer preferentially metastasizes to **bone (especially axial skeleton), lymph nodes, and liver** - Brain metastases from prostate cancer suggest extremely advanced, aggressive disease and are exceptionally uncommon

Neuropathology US Medical PG Question 5: A 70-year-old woman is brought to the office after her nurse noticed her being apathetic, easily distracted, and starting to urinate in bed. Her medical history is relevant for hypertension, under control with medication. Physical examination reveals a blood pressure of 138/76 mm Hg, a heart rate of 70/min, and a respiratory rate 14/min and regular. On neurological examination, she has a broad-based shuffling gait, and increased muscle tone in her limbs that is reduced by distracting the patient. There is decreased coordination with exaggerated deep tendon reflexes, decreased attention and concentration, and postural tremor. Which of the following additional features would be expected to find in this patient?

• A. Degeneration of the substantia nigra pars compacta
• B. Caudate head atrophy
• C. Accumulation of Lewy bodies in cortical cells
• D. Dilation of the ventricular system (Correct Answer)
• E. Accumulation of amyloid plaques and neurofibrillary tangles in the cerebral cortex

Neuropathology Explanation: ***Dilation of the ventricular system*** - The patient presents with a classic triad of **gait apraxia** (broad-based, shuffling gait), **dementia** (apathy, distractibility, decreased attention and concentration), and **urinary incontinence**, which are the hallmark symptoms of **Normal Pressure Hydrocephalus (NPH)**. NPH is characterized by **ventricular dilation without increased intracranial pressure**. - Other features like **increased muscle tone that reduces with distraction** (frontal release sign), **exaggerated deep tendon reflexes**, and **postural tremor** further support the diagnosis of NPH, as these are often seen due to involvement of frontal lobe pathways secondary to ventricular enlargement. *Degeneration of the substantia nigra pars compacta* - This is characteristic of **Parkinson's disease**, which typically presents with a rest tremor, bradykinesia, rigidity, and postural instability, but not typically with prominent early dementia and urinary incontinence in this combined clinical picture. - While Parkinson's can cause gait disturbance, the specific combination of symptoms (dementia, incontinence, and gait apraxia) points away from primary Parkinson's as the most likely diagnosis. *Caudate head atrophy* - **Caudate head atrophy** is a hallmark finding in **Huntington's disease**, which is characterized by chorea, psychiatric symptoms, and progressive cognitive decline. - The patient's symptoms, particularly the broad-based shuffling gait and urinary incontinence, are inconsistent with the typical presentation of Huntington's disease. *Accumulation of Lewy bodies in cortical cells* - This is a pathological feature of **Lewy body dementia (LBD)**. While LBD presents with dementia and Parkinsonian features, it also typically includes **recurrent visual hallucinations** and **fluctuations in attention and alertness**, which are not specified in this patient's presentation. - The patient's dominant features of gait apraxia and urinary incontinence along with dementia are more indicative of NPH. *Accumulation of amyloid plaques and neurofibrillary tangles in the cerebral cortex* - These are the pathological hallmarks of **Alzheimer's disease**, which primarily presents with progressive memory loss, executive dysfunction, and other cognitive deficits. - While dementia is a feature in this patient, the prominent gait disturbance and urinary incontinence are not typical early or dominant features of Alzheimer's disease.

Neuropathology US Medical PG Question 6: A research group wants to assess the safety and toxicity profile of a new drug. A clinical trial is conducted with 20 volunteers to estimate the maximum tolerated dose and monitor the apparent toxicity of the drug. The study design is best described as which of the following phases of a clinical trial?

• A. Phase 0
• B. Phase III
• C. Phase V
• D. Phase II
• E. Phase I (Correct Answer)

Neuropathology Explanation: ***Phase I*** - **Phase I clinical trials** involve a small group of healthy volunteers (typically 20-100) to primarily assess **drug safety**, determine a safe dosage range, and identify side effects. - The main goal is to establish the **maximum tolerated dose (MTD)** and evaluate the drug's pharmacokinetic and pharmacodynamic profiles. *Phase 0* - **Phase 0 trials** are exploratory studies conducted in a very small number of subjects (10-15) to gather preliminary data on a drug's **pharmacodynamics and pharmacokinetics** in humans. - They involve microdoses, not intended to have therapeutic effects, and thus cannot determine toxicity or MTD. *Phase III* - **Phase III trials** are large-scale studies involving hundreds to thousands of patients to confirm the drug's **efficacy**, monitor side effects, compare it to standard treatments, and collect information that will allow the drug to be used safely. - These trials are conducted after safety and initial efficacy have been established in earlier phases. *Phase V* - "Phase V" is not a standard, recognized phase in the traditional clinical trial classification (Phase 0, I, II, III, IV). - This term might be used in some non-standard research contexts or for post-marketing studies that go beyond Phase IV surveillance, but it is not a formal phase for initial drug development. *Phase II* - **Phase II trials** involve several hundred patients with the condition the drug is intended to treat, focusing on **drug efficacy** and further evaluating safety. - While safety is still monitored, the primary objective shifts to determining if the drug works for its intended purpose and at what dose.

Neuropathology US Medical PG Question 7: A 45-year-old man is brought to the hospital by his daughter with complaints of wide-based gait. His daughter reveals that he was sitting silently in the examination chair with a blank face. In addition, he was frequently talking to the empty chairs and told that his friends are sitting there. He has been forgetting many small things recently. On physical examination, fine movements are seen at resting condition that disappears when he is asked to drink water. A stepwise slowness in movement is also seen in his upper limb. Which of the following is most likely to be observed in the histological specimen of this patient?

• A. Spongiform changes in cortex
• B. Neuritic plaques in cortex
• C. Lewy bodies in affected neurons (Correct Answer)
• D. Tau protein aggregates in cortex
• E. Neurofibrillary tangles in hippocampus

Neuropathology Explanation: ***Lewy bodies in affected neurons*** - The patient's symptoms of **wide-based gait**, **cognitive decline** (forgetting things, talking to empty chairs), **psychotic features** (visual hallucinations), and **motor symptoms** (resting tremor, bradykinesia) are highly suggestive of **Lewy body dementia** (LBD). - **Lewy bodies**, which are abnormal aggregates of **alpha-synuclein protein**, are the characteristic histological finding in neurons of individuals with LBD, found in both **cortical areas** (defining feature of LBD) and **substantia nigra**. - The presence of early prominent visual hallucinations with parkinsonism and cognitive fluctuations is pathognomonic for Lewy body dementia. *Spongiform changes in cortex* - This finding is characteristic of **prion diseases**, such as **Creutzfeldt-Jakob disease** (CJD), which typically present with rapidly progressive dementia and myoclonus. - While CJD involves cognitive decline, the presence of resting tremor, visual hallucinations, and a more gradual progression with parkinsonian features makes spongiform changes unlikely. *Neuritic plaques in cortex* - **Neuritic plaques**, composed of **amyloid-beta protein**, are a hallmark of **Alzheimer's disease**. - Although Alzheimer's disease causes cognitive decline, the prominent early motor symptoms (resting tremor, wide-based gait, bradykinesia) and early visual hallucinations are not typical features of Alzheimer's disease. *Tau protein aggregates in cortex* - **Tau protein aggregates** (neurofibrillary tangles) are another key histological feature of **Alzheimer's disease** and certain **tauopathies** like **frontotemporal dementia** and **progressive supranuclear palsy**. - While associated with dementia, they do not explain the unique combination of early parkinsonian motor features and prominent visual hallucinations seen in this patient. *Neurofibrillary tangles in hippocampus* - **Neurofibrillary tangles** composed of hyperphosphorylated **tau protein** in the hippocampus are characteristic of **Alzheimer's disease** and correlate with memory impairment. - However, Alzheimer's disease does not typically present with early parkinsonism, resting tremor, or prominent visual hallucinations as seen in this patient with Lewy body dementia.

Neuropathology US Medical PG Question 8: An 81-year-old woman presents to your office accompanied by her husband. She has been doing well except for occasional word finding difficulty. Her husband is concerned that her memory is worsening over the past year. Recently, she got lost twice on her way home from her daughter’s house, was unable to remember her neighbor’s name, and could not pay the bills like she usually did. She has a history of hypertension and arthritis. She has no significant family history. Her medications include a daily multivitamin, hydrochlorothiazide, and ibuprofen as needed. Physical exam is unremarkable. Which of the following is associated with an increased risk of this patient’s disease?

• A. Presenilin-2
• B. ApoE2
• C. ApoE4 (Correct Answer)
• D. Female gender
• E. Advanced age (>85 years)

Neuropathology Explanation: ***Correct: ApoE4*** - The patient's symptoms (progressive memory loss, getting lost on familiar routes, difficulty with routine tasks like paying bills) in an 81-year-old suggest **Alzheimer's disease**. - The **ApoE4 allele** is a well-established genetic risk factor for **late-onset Alzheimer's disease**, significantly increasing the likelihood (3-fold increased risk for one allele, 12-fold for two alleles) and often lowering the age of onset. - ApoE4 is the **most specific and discriminating risk factor** among the options provided. *Incorrect: Presenilin-2* - **Presenilin-2** mutations are associated with **early-onset familial Alzheimer's disease**, which typically manifests before age 65 and often has a strong family history. - This patient is 81 years old and has no significant family history, making early-onset familial AD unlikely. *Incorrect: ApoE2* - The **ApoE2 allele** is actually associated with a **decreased risk** of Alzheimer's disease. - It is thought to be protective due to its more efficient clearance of amyloid beta peptides from the brain. *Incorrect: Female gender* - While **female gender** is indeed a risk factor for Alzheimer's disease (women have approximately 2:1 higher lifetime risk even after adjusting for longevity), it is less specific than ApoE4 as a discriminating answer. - All patients have a biological sex, but only some carry the ApoE4 allele, making ApoE4 a more useful clinical and epidemiological marker. *Incorrect: Advanced age (>85 years)* - **Advanced age** is actually the strongest non-modifiable risk factor for Alzheimer's disease, with incidence doubling every 5 years after age 65. - However, in the context of this question, **ApoE4 is the better answer** because it represents a specific genetic risk factor that can be tested and is directly associated with disease pathogenesis, whereas advanced age is a universal demographic factor that applies to all individuals who live long enough.

Neuropathology US Medical PG Question 9: A 53-year-old woman presents to her physician for evaluation of sudden onset respiratory distress for the past few hours. The past medical history includes a myocardial infarction 2 years ago. The vital signs include a blood pressure 70/40 mm Hg, pulse 92/min, respiratory rate 28/min, and SpO2 92% on room air. The physical examination reveals bilateral basal crepitations on auscultation. The echocardiogram reveals an ejection fraction of 34%. She is admitted to the medical floor and started on furosemide. The urine output in 24 hours is 400 mL. The blood urea nitrogen is 45 mg/dL and the serum creatinine is 1.85 mg/dL. The fractional excretion of sodium is 2.4%. Urinalysis revealed muddy brown granular casts. Which of the following is the most likely cause of the abnormal urinalysis?

• A. Acute interstitial nephritis
• B. Acute tubular necrosis (Correct Answer)
• C. Acute pyelonephritis
• D. Chronic kidney disease
• E. Acute glomerulonephritis

Neuropathology Explanation: ***Acute tubular necrosis*** - The presence of **muddy brown granular casts** on urinalysis is pathognomonic for **acute tubular necrosis (ATN)**, indicating damage to the renal tubules. - The patient's history of **cardiogenic shock** (low BP 70/40 mm Hg, respiratory distress, low SpO2, low ejection fraction of 34%) led to **renal hypoperfusion** and ischemic tubular injury. - The **fractional excretion of sodium (FENa) of 2.4%** (>2%) is characteristic of **intrinsic renal injury** (ATN), as damaged tubules cannot effectively reabsorb sodium. - **Oliguria** (400 mL/24 hours), elevated **BUN (45 mg/dL)** and **creatinine (1.85 mg/dL)** further support acute kidney injury from ATN. *Acute interstitial nephritis* - This condition is typically associated with **drug hypersensitivity** (e.g., NSAIDs, antibiotics, PPIs) or **infections** and is characterized by inflammatory infiltrate in the renal interstitium. - Urinalysis typically shows **white blood cell casts** and **eosinophiluria**, not muddy brown granular casts. *Acute pyelonephritis* - This is an **infection of the kidney** parenchyma, usually caused by bacterial ascension from the urinary tract. - Symptoms often include **fever, flank pain, dysuria**, and urinalysis reveals **leukocyturia** (white blood cells) and **bacterial casts**, not muddy brown granular casts. *Chronic kidney disease* - While the patient has elevated creatinine and BUN, **chronic kidney disease (CKD)** develops over months to years and is characterized by persistent kidney damage or decreased function. - Urinalysis in CKD often shows **broad waxy casts** and typically does not present with such **acute, sudden onset** of severe renal dysfunction with muddy brown granular casts. *Acute glomerulonephritis* - This condition involves inflammation of the glomeruli and typically presents with **hematuria, proteinuria, and red blood cell casts** (dysmorphic RBCs). - The patient's clinical picture, including the absence of significant hematuria and the presence of **muddy brown granular casts**, does not fit acute glomerulonephritis.

Neuropathology US Medical PG Question 10: A 52-year-old man presents with 2 months of diarrhea, abdominal pain, and fatigue. He reports a weight loss of 4 kg (8 lb). He also says his joints have been hurting recently, as well. Past medical history is unremarkable. Review of systems is significant for problems with concentration and memory. Physical examination is unremarkable. A GI endoscopy is performed with a biopsy of the small bowel. Which of the following histologic finding would most likely be seen in this patient?

• A. PAS positive macrophages (Correct Answer)
• B. Non-caseating granulomas in the small intestine
• C. Absence of nerves in the myenteric plexus
• D. Blunting of the villi
• E. Crypt hyperplasia with increased intraepithelial lymphocytes

Neuropathology Explanation: **PAS positive macrophages** - The clinical presentation with **diarrhea**, abdominal pain, weight loss, joint pain, and **neurological symptoms** (problems with concentration and memory) is classic for **Whipple's disease**. - **Whipple's disease** is caused by the bacterium **Tropheryma whipplei**, which is characterized histologically by **foamy macrophages** in the lamina propria that stain **positive with Periodic Acid-Schiff (PAS)** due to undigested bacterial cell wall material. *Non-caseating granulomas in the small intestine* - **Non-caseating granulomas** are characteristic of **Crohn's disease**, which typically presents with abdominal pain, diarrhea, and weight loss, but **neurological symptoms** are not a primary feature. - While Crohn's disease can cause joint pain (arthritis), the combination of GI and neurological symptoms points away from it. *Absence of nerves in the myenteric plexus* - An **absence of nerves in the myenteric plexus** is the hallmark of **Hirschsprung's disease**, which is a congenital disorder primarily affecting neonates and infants, causing intestinal obstruction and chronic constipation. - This finding is inconsistent with the patient's age and presenting symptoms of diarrhea and neurological issues. *Blunting of the villi* - **Villi blunting** is characteristic of **celiac disease** (gluten-sensitive enteropathy), which presents with malabsorption symptoms like diarrhea, weight loss, and abdominal pain. - However, **celiac disease** typically does not involve **neurological symptoms** like concentration and memory problems as a prominent feature, and the PAS-positive macrophages are specific to Whipple's. *Crypt hyperplasia with increased intraepithelial lymphocytes* - **Crypt hyperplasia** and **increased intraepithelial lymphocytes (IELs)** are seen in various small bowel pathologies, including **celiac disease** and **microscopic colitis**. - While these findings suggest intestinal inflammation, they are not specific to **Whipple's disease** and do not account for the characteristic neurological involvement.

Neuropathology Flashcard 1 of 10

Question: Alzheimer disease is characterized by widespread cortical _____

Answer: atrophy

Neuropathology Flashcard 2 of 10

Question: Amyloid may be visualized using _____ staining

Answer: Congo red

Neuropathology Flashcard 3 of 10

Question: Spongiform encephalopathy is characterized histologically by intracellular _____ due to damage to neurons and glial cells

Answer: vacuoles

Neuropathology Flashcard 4 of 10

Question: Frontotemporal dementia (Pick disease) may have ubiquitinated _____ inclusions seen on histology

Answer: TDP-43

Neuropathology Flashcard 5 of 10

Question: Lewy body dementia is characterized by intracellular lewy bodies primarily in the _____

Answer: cortex (location in the brain)

Neuropathology Flashcard 6 of 10

Question: Alzheimer disease is characterized by deposition of _____ in the brain, which forms amyloid plaques

Answer: A-amyloid

Neuropathology Flashcard 7 of 10

Question: What is the term for infarcted tissue in the basal ganglia or internal capsule caused by occlusion of a lenticulostriate artery?

Answer: lacunar infarct

Neuropathology Flashcard 8 of 10

Question: epidural hematoma

Answer: rupture of middle meningeal artery; fracture of temporal bone

Extra Information: rapid arterial bleedinglucid interval followed by decreased LOC; CN 3 palsy, increased ICPCT: biconvex, hyperdense blood; does not cross sutures; may cross falx, tentorium 

Neuropathology Flashcard 9 of 10

Question: central pontine myelinolysis

Answer: often iatrogenic; caused by rapid correction of hyponatremia

Extra Information: massive axonal demyelination of pontine white matter tractsacute paralysis, dysarthria, dysphagia, diplopia, loss of consciousness; +/- locked-in syndromeT2 MRI: increased signal in central pons 

Neuropathology Flashcard 10 of 10

Question: subdural hematoma

Answer:

Extra Information: slow venous bleeding via rupture of bridging veinsdecreased LOC, increased ICPCT: crescent shaped, hyperdense blood; midline shift; may cross sutures; does not cross falx, tentorium brain atrophyelderly, alcoholics