Neuropathology Practice Questions

Q: Which is the most common childhood CNS tumor to metastasize outside the brain?

Medulloblastoma. **Explanation:** **Medulloblastoma** is a highly malignant Grade 4 embryonal tumor arising from the cerebellum. It is the most common malignant brain tumor in children [1]. Its propensity for metastasis is a hallmark feature: 1. **Leptomeningeal Spread:** It frequently spreads via the cerebrospinal fluid (CSF) to the spinal cord, often referred to as "drop metastases." [1] 2. **Extracranial Metastasis:** While CNS tumors rarely spread outside the blood-brain barrier, Medulloblastoma is the most common childhood CNS tumor to do so. The most frequent site for systemic spread is the **bone**, followed by lymph nodes and liver. This often occurs via ventriculoperitoneal (VP) shunts or hematogenous routes. **Analysis of Incorrect Options:** * **Ependymoma:** While these can show CSF seeding (especially the posterior fossa subtype), systemic metastasis is extremely rare compared to medulloblastoma. * **Glioblastoma Multiforme (GBM):** This is the most common primary malignant brain tumor in *adults*. While it is highly invasive locally, it rarely metastasizes outside the CNS in children. * **Choroid Plexus Tumor:** These are rare tumors. While Choroid Plexus Carcinomas can seed the subarachnoid space, they do not have the same high incidence of systemic metastasis as medulloblastoma. **High-Yield Clinical Pearls for NEET-PG:** * **Histology:** Look for **Homer-Wright rosettes** (pseudorosettes) and small round blue cells. * **Location:** Arises from the **vermis** in children (midline) and cerebellar hemispheres in adults. * **Genetics:** WNT pathway mutations carry the best prognosis; SHH and Group 3/4 have poorer outcomes. * **Radiology:** Appears as a hyperdense mass on CT in the fourth ventricle, causing obstructive hydrocephalus. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1314-1315.

Q: All of the following are features of Pick's disease except?

Hirano bodies. **Pick’s Disease** (a subtype of Frontotemporal Dementia) is characterized by progressive atrophy of the frontal and temporal lobes [1]. ### Why "Hirano bodies" is the correct answer: **Hirano bodies** are eosinophilic, rod-like inclusions found primarily in the pyramidal cells of the hippocampus. While they are associated with aging, they are a hallmark histological feature of **Alzheimer’s disease**, not Pick’s disease. ### Explanation of incorrect options: * **Knife-edge/Blade atrophy (Option A):** This is the classic macroscopic description of Pick’s disease. Severe, asymmetric atrophy of the frontal and temporal gyri leads to thinning so pronounced that the gyri resemble the sharp edge of a knife [1]. * **Walnut brain (Option B):** This refers to the gross appearance of the brain in Pick’s disease. Because the atrophy is sharply circumscribed to the frontal and temporal lobes (sparing the parietal and occipital lobes), the brain takes on the shriveled appearance of a walnut shell. * **Ballooning degeneration (Option C):** Also known as **Pick cells**, these are surviving neurons that appear swollen (ballooned) with cleared-out cytoplasm and displaced nuclei, representing a specific pattern of neuronal injury in this condition. ### High-Yield Clinical Pearls for NEET-PG: * **Pick Bodies:** These are the pathognomonic microscopic findings—spherical, silver-staining (Argyrophilic) cytoplasmic inclusions made of **3R Tau protein**. * **Clinical Presentation:** Unlike Alzheimer’s (which starts with memory loss), Pick’s disease presents early with **personality changes**, social disinhibition, and language impairment. * **Sparing:** Note that the posterior two-thirds of the superior temporal gyrus is typically spared [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1294-1296.

Q: Duret's haemorrhage is typically seen in which part of the brain?

Midbrain and pons. **Explanation:** **Duret hemorrhages** are small, linear or flame-shaped hemorrhages occurring in the midline of the **midbrain and upper pons** [1]. **Pathophysiology:** These hemorrhages are a secondary complication of **transtentorial (uncal) herniation** [1]. When a space-occupying lesion (like a hematoma or tumor) causes the brain to displace downward, it stretches and tears the perforating branches of the **basilar artery** and/or the draining veins [1]. This mechanical shearing leads to focal ischemia and hemorrhagic infarction within the brainstem parenchyma. **Analysis of Options:** * **Option C (Midbrain and pons):** This is the correct anatomical site. The displacement of the brainstem downward through the tentorial notch specifically stresses the vessels supplying these regions [1]. * **Option A (Retina):** Retinal hemorrhages are associated with conditions like hypertension, diabetes, or Terson syndrome (subarachnoid hemorrhage), but are not termed Duret hemorrhages. * **Option B (Ventricles):** Bleeding into the ventricles is termed intraventricular hemorrhage (IVH), commonly seen in germinal matrix hemorrhages in neonates or as an extension of intraparenchymal bleeds in adults. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Sign:** Duret hemorrhages usually signify a fatal progression of increased intracranial pressure; they often present clinically with a rapid decline in consciousness and fixed/dilated pupils. * **Association:** Always link Duret hemorrhage with **Uncal Herniation** and the **Basilar Artery** [1]. * **Morphology:** On a CT scan or autopsy, they appear as "flame-shaped" streaks in the midline of the brainstem (tegmentum) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1257-1258.

Question 1

What is the most common intracranial neoplasm?

Accepted Answer

Metastasis

Answer

Gliomas

Answer

Meningioma

Answer

Schwannoma

Question 2

Pick's body in Pick's disease is composed of which protein?

Accepted Answer

Tau protein

Answer

Alpha synuclein

Answer

Beta synuclein

Answer

Aβ amyloid

Question 3

Antoni type A and type B cells are characteristic of which of the following tumors?

Accepted Answer

Neurilemmoma

Answer

Neurofibroma

Answer

Neurofibrosarcoma

Answer

Traumatic neuroma

Question 4

Which is the most common childhood CNS tumor to metastasize outside the brain?

Accepted Answer

Medulloblastoma

Answer

Ependymoma

Answer

Glioblastoma multiforme

Answer

Choroid plexus tumor

Question 5

Lewy bodies are found in the substantia nigra neurons in which of the following conditions?

Accepted Answer

Parkinson disease

Answer

Alzheimer disease

Answer

Huntington disease

Answer

Pick disease

Question 6

All of the following are features of Pick's disease except?

Accepted Answer

Hirano bodies

Answer

Knife blade atrophy

Answer

Walnut brain

Answer

Ballooning degeneration

Question 7

Kuru plaques are seen in which of the following neurodegenerative disorders?

Accepted Answer

Creutzfeldt-Jakob Disease (CJD)

Answer

Alzheimer disease

Answer

Parkinson disease (PD)

Answer

Multiple system atrophy (MSA)

Question 8

Which part of the brain is most resistant to hypoxia?

Accepted Answer

Structures in the brainstem

Answer

Cerebral cortex

Answer

Basal ganglia

Answer

Thalamus

Question 9

Duret's haemorrhage is typically seen in which part of the brain?

Accepted Answer

Midbrain and pons

Answer

Retina

Answer

Ventricles

Answer

None of the above

Question 10

In Alzheimer's disease, what is plaque primarily composed of?

Accepted Answer

Beta amyloid

Answer

Tau protein

Answer

Huntington

Answer

Alpha synuclein

Neuropathology — MCQs

Neuropathology — MCQs

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