Neuropathology Practice Questions

Q: Marchiafava-Bignami disease is characterized by which of the following?

Callosal atrophy. **Explanation:** **Marchiafava-Bignami Disease (MBD)** is a rare, progressive neurological disorder characterized by symmetric **demyelination and necrosis of the corpus callosum**. 1. **Why Callosal Atrophy is Correct:** The primary pathology in MBD involves the destruction of the central layers of the corpus callosum (the "sandwich sign" on MRI). Chronic cases lead to significant thinning and **callosal atrophy**. It is classically associated with chronic alcoholism, particularly the consumption of inexpensive red wine, though it is now understood to be linked more broadly to malnutrition and alcohol-induced metabolic derangements. 2. **Why Other Options are Incorrect:** * **Cerebellar Atrophy:** This is a hallmark of chronic alcohol abuse (specifically affecting the anterior vermis), but it is not the defining feature of MBD. * **Brainstem Atrophy:** Typically seen in neurodegenerative conditions like Progressive Supranuclear Palsy (PSP) or Multiple System Atrophy (MSA-P). * **Cerebral Peduncular Atrophy:** Usually occurs secondary to Wallerian degeneration following a massive cortical stroke (infarction of the internal capsule). **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Dementia, gait instability, and dysarthria in a chronic alcoholic. * **Imaging Gold Standard:** MRI shows T2/FLAIR hyperintensities in the corpus callosum (acute) or thinning/atrophy (chronic). * **Differential Diagnosis:** Must be distinguished from **Wernicke Encephalopathy** (affects mammillary bodies/thalamus) and **Central Pontine Myelinolysis** (affects the pons). * **Key Pathological Feature:** Symmetrical demyelination of the body of the corpus callosum, often sparing the dorsal and ventral edges.

Q: Duret Hemorrhages are seen in which organ?

Brain. **Explanation:** **Duret hemorrhages** are small, linear or flame-shaped hemorrhages occurring in the **midbrain and pons** [1]. They are a classic manifestation of severe intracranial pathology, specifically resulting from **transtentorial (uncal) herniation** [1]. **Why the Brain is Correct:** When intracranial pressure (ICP) rises significantly (due to a tumor, hematoma, or edema), the brain tissue is displaced downward through the tentorial notch. This mechanical shift causes the stretching and tearing of the **perforating branches of the basilar artery** and/or the draining veins [1]. The resulting ischemia and rupture lead to focal hemorrhages in the brainstem (midbrain and pons), which are often fatal as they affect vital cardiac and respiratory centers. **Why Other Options are Incorrect:** * **Lung:** Hemorrhages here are typically associated with pulmonary embolism (infarction), trauma, or Goodpasture syndrome, but are never referred to as Duret hemorrhages. * **Kidney:** Renal hemorrhages or infarcts are usually due to emboli or vasculitis. * **Heart:** Myocardial hemorrhages are generally associated with reperfusion injury or trauma. **High-Yield Clinical Pearls for NEET-PG:** * **Location:** Specifically the midline of the **midbrain and upper pons** [1]. * **Mechanism:** Secondary to **descending transtentorial herniation** [1]. * **Clinical Significance:** Usually indicates a terminal event or a very poor prognosis. * **Differential:** Do not confuse with **Kernohan’s notch**, which is a groove in the cerebral peduncle caused by compression against the tentorium, leading to ipsilateral hemiparesis (a false localizing sign). **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.

Q: What is the characteristic histopathological finding of Hirano bodies?

Alzheimer's disease. **Explanation:** **Hirano bodies** are eosinophilic, rod-like or cucumber-shaped intracellular inclusions found primarily within the pyramidal neurons of the **hippocampus**. Ultrastructurally, they consist of paracrystalline arrays of actin and actin-associated proteins. * **Why Alzheimer’s Disease (AD) is correct:** While Hirano bodies can be seen in normal aging, they are significantly more numerous in neurodegenerative conditions, most characteristically **Alzheimer’s disease** [1]. They represent a breakdown in the cytoskeleton and are considered one of the microscopic hallmarks of AD, alongside neurofibrillary tangles (tau protein) and neuritic plaques (amyloid-beta) [1]. **Analysis of Incorrect Options:** * **A. Rabies:** Characterized by **Negri bodies**, which are eosinophilic, round-to-oval cytoplasmic inclusions found typically in Purkinje cells of the cerebellum and pyramidal cells of the hippocampus. * **C. Pick’s Disease:** Characterized by **Pick bodies**, which are round, silver-staining (argyrophilic) cytoplasmic inclusions made of 3R tau protein [2]. * **D. Viral Encephalitis:** Often presents with **Cowdry Type A** inclusions (e.g., Herpes Simplex Virus) or microglial nodules, rather than actin-rich Hirano bodies. **High-Yield Clinical Pearls for NEET-PG:** * **Hirano bodies = Actin** (High-yield biochemical component). * **Location:** Hippocampus (Sommer’s sector/CA1). * **Alzheimer’s Histology Triad:** Neuritic (Senile) plaques, Neurofibrillary tangles, and Granulovacuolar degeneration/Hirano bodies [1]. * **Silver Stains:** Used for plaques and tangles, but Hirano bodies are easily seen on routine **H&E stain**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1292-1294. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1294-1295.

Question 1

A 68-year-old obese woman (BMI = 34 kg/m2) suffers a stroke and expires. Histologic examination of the brain at autopsy reveals extensive arteriolar lipohyalinosis and numerous Charcot-Bouchard aneurysms. Which of the following best accounts for the pathogenesis of these autopsy findings?

Accepted Answer

Hypertension

Answer

Atherosclerosis

Answer

Autoimmunity

Answer

Diabetes

Question 2

A 5-year-old child presents with a posterior fossa mass. A biopsy of the mass reveals rosettes. What is the most likely histological feature observed?

Accepted Answer

Homer Wright rosette

Answer

Perivascular pseudorosette

Answer

Flexner-Wintersteiner rosette

Answer

None of the above

Question 3

Which of the following is NOT a characteristic feature of cerebral malaria?

Accepted Answer

Lesion is not related to the parasite

Answer

Perivascular demyelination

Answer

Durck granuloma

Answer

Proliferated glial cells arranged radially

Question 4

Marchiafava-Bignami disease is characterized by which of the following?

Accepted Answer

Callosal atrophy

Answer

Cerebellar atrophy

Answer

Brainstem atrophy

Answer

Cerebral peduncular atrophy

Question 5

Which of the following is NOT a feature of Alzheimer's disease?

Accepted Answer

Narrowing of ventricles

Answer

Hirano bodies

Answer

Amyloid deposits

Answer

Neuritic plaques

Question 6

Which of the following is NOT a cellular event in the sequence of an ischemic brain infarct?

Accepted Answer

Ingress of macrophages and apoptosis

Answer

Intense neuronal eosinophilia

Answer

Influx of polymorphonuclear neutrophils (PMNs)

Answer

Proliferation of astrocytes

Question 7

Duret Hemorrhages are seen in which organ?

Accepted Answer

Brain

Answer

Lung

Answer

Kidney

Answer

Heart

Question 8

What is the commonest type of intracranial tumor in adults?

Accepted Answer

Astrocytoma

Answer

Medulloblastoma

Answer

Neurofibroma

Answer

Secondaries

Question 9

What is the characteristic histopathological finding of Hirano bodies?

Accepted Answer

Alzheimer's disease

Answer

Rabies

Answer

Pick's disease

Answer

Viral encephalitis

Question 10

What is the most common nerve in the neck from which schwannoma arises?

Accepted Answer

Vestibular portion of the acoustic nerve

Answer

Trigeminal nerve

Answer

Accessory nerve

Answer

Hypoglossal nerve

Neuropathology — MCQs

Neuropathology — MCQs

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