Neuropathology Practice Questions

Q: Most common supratentorial tumor in children

Craniopharyngioma. ***Craniopharyngioma*** - **Craniopharyngiomas** are the **most common supratentorial tumors in children**, accounting for approximately 5-10% of all pediatric intracranial tumors. - They arise from **Rathke's pouch remnants** near the pituitary gland and hypothalamus in the **sellar/suprasellar region**. - Present with **visual disturbances, endocrine dysfunction, and increased intracranial pressure**. - Bimodal age distribution with peaks at **5-14 years** and 50-74 years. *Astrocytoma* - While **astrocytomas** are the **most common primary CNS tumors in children overall**, they are predominantly located in the **posterior fossa (infratentorial)**, particularly as **cerebellar astrocytomas** [1], [2]. - In the **supratentorial compartment specifically**, astrocytomas are less common than craniopharyngiomas in the pediatric population. - They arise from **astrocytes** and range from low-grade (pilocytic) to high-grade (glioblastoma) [1]. *Oligodendroglioma* - **Oligodendrogliomas** are **rare in children** and more prevalent in adults (peak 40-50 years). - They originate from **oligodendrocytes** and are typically **slow-growing tumors**. - Account for only 1-2% of pediatric brain tumors. *Meningioma* - **Meningiomas** are **very rare in children** (less than 2% of pediatric brain tumors) and are primarily tumors of adulthood. - They arise from **arachnoid cap cells** of the meninges and show increasing incidence with age. - When they occur in children, they are often associated with **neurofibromatosis type 2** [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 725-726. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1319-1320.

Q: The site of occurrence of Subependymal Giant Cell Astrocytoma is

Foramen of Monro. ***Foramen of Monro*** - **Subependymal Giant Cell Astrocytoma (SEGA)** is predominantly found near the **foramen of Monro**, growing into the **lateral ventricles**. - Its location often leads to **hydrocephalus** due to obstruction of cerebrospinal fluid flow at this strategic point [1]. *Medulla Oblongata* - Tumors in the medulla oblongata are rare, and SEGA is not typically associated with this brainstem region. - Tumors here would likely present with lower cranial nerve palsies or brainstem dysfunction, distinct from SEGA symptoms. *Cerebellum* - The cerebellum is a common site for other pediatric brain tumors like **pilocytic astrocytoma** or **medulloblastoma** [2], [4]. - SEGA does not primarily occur in the cerebellum. *Pineal gland* - The pineal gland is the site for pineal region tumors, such as **pineoblastoma** or **germinoma** [3]. - SEGA is not found in the pineal region. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 703-704. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 725-726. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1314-1315.

Q: Schwannoma arises most frequently from:

Vestibular Nerve. ***Vestibular Nerve*** - Schwannomas, particularly **vestibular schwannomas** (also known as acoustic neuromas), arise most frequently from the Schwann cells of the vestibular portion of the eighth cranial nerve [1]. - These are benign tumors that grow slowly and can cause hearing loss, tinnitus, and balance problems [1]. *Trigeminal nerve* - Schwannomas can occur on the trigeminal nerve, but they are **less common** than vestibular schwannomas [1]. - Trigeminal schwannomas can present with facial pain, numbness, or weakness. *Facial Nerve* - Schwannomas of the facial nerve are **rare** and often present with facial paralysis or involuntary twitching. - They are significantly less frequent compared to those originating from the vestibular nerve. *Cochlear Nerve* - While the cochlear nerve is part of the vestibulocochlear nerve (cranial nerve VIII), schwannomas predominantly arise from the **vestibular branch** rather than the cochlear branch itself [1]. - Therefore, primary cochlear nerve schwannomas are relatively uncommon compared to vestibular schwannomas. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 727-728.

Q: Which of the following is the most frequent primary malignant tumor of the CNS?

Glioblastoma multiforme. ***Glioblastoma multiforme*** - **Glioblastoma multiforme (GBM)** is the most common and aggressive primary malignant brain tumor in adults [1]. - It is a **grade IV astrocytoma**, characterized by rapid growth, necrosis, and microvascular proliferation [1]. *Oligodendroglioma* - **Oligodendrogliomas** are primary glial tumors but are less common than GBM. - They typically have a more indolent course than GBM and are often characterized by **IDH mutations** and **1p/19q co-deletion**. *Medulloblastoma* - **Medulloblastoma** is the most common malignant brain tumor in children, but it is rare in adults [2]. - It arises in the **cerebellum** and is a type of embryonal tumor [2]. *Meningioma* - **Meningiomas** are the most common primary brain tumors overall, but they are typically **benign** and originate from the meninges. - While they can be symptomatic due to compression, they are not primarily malignant in the way GBM is. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1308-1310. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 725-726.

Q: Lumbar puncture was done in a patient with raised intracranial tension. The patient died suddenly on the table. The cause of the death is most likely to be

Tentorial herniation. ***Tentorial herniation*** - In a patient with **raised intracranial pressure (ICP)**, performing a lumbar puncture can cause a rapid drop in spinal CSF pressure, creating a pressure gradient that forces the **brainstem** through the **tentorial notch**. [1] - This sudden compression of the brainstem, specifically the **medulla oblongata**, can lead to **respiratory and circulatory center dysfunction**, resulting in rapid death. [1] *Rupture of an aneurysm* - While a ruptured aneurysm can cause sudden death, it typically presents with a sudden, severe headache (**thunderclap headache**) and neurological deficits, not directly as a result of a lumbar puncture in this context. [2] - Aneurysm rupture is a spontaneous event and not directly induced by a change in CSF pressure during a lumbar puncture. *Middle cerebral artery hemorrhage* - A **middle cerebral artery (MCA) hemorrhage** would present with focal neurological deficits such as hemiparesis, aphasia, or neglect, depending on the affected hemisphere. - It is a type of stroke and not a direct complication of a lumbar puncture in a patient with raised ICP. *Loss of CSF* - While **CSF leakage** is a potential complication of a lumbar puncture, it typically leads to a **post-lumbar puncture headache** (low-pressure headache) due to reduced intracranial pressure. - It does not directly cause sudden death on the table, as the primary risk in raised ICP is herniation, not the mere loss of CSF volume.

Q: The characteristic feature of Lhermitte-Duclos disease is:

Thickened cerebellar folia. ***Thickened cerebellar folia*** - **Lhermitte-Duclos disease**, also known as **dysplastic gangliocytoma of the cerebellum**, is characterized by a **hamartomatous overgrowth** of the granular layer of the cerebellum. - This overgrowth leads to **thickened, abnormal cerebellar folia** that can exert mass effect on surrounding structures. *Atrophic cerebellar folia* - **Cerebellar atrophy** involves the loss of cerebellar tissue, resulting in **thinned or shrunken folia**, which is the opposite of Lhermitte-Duclos disease. - Atrophy is typically seen in neurodegenerative conditions, chronic alcohol abuse, or certain genetic disorders. *Septum pellucidum agenesis* - **Septum pellucidum agenesis** is the absence of the septum pellucidum, a thin membrane separating the lateral ventricles, and is associated with conditions like **septo-optic dysplasia** or certain chromosome abnormalities. - This is a structural anomaly of the forebrain, **unrelated to cerebellar pathology** like Lhermitte-Duclos disease. *Vermian hypoplasia* - **Vermian hypoplasia** refers to the **underdevelopment of the cerebellar vermis**, a central part of the cerebellum, often seen in conditions like **Dandy-Walker malformation** or Joubert syndrome. - While it affects cerebellar development, it is primarily a **volume reduction** rather than a specific dysplastic overgrowth of the folia.

Q: Which part of brain shows consistent changes in heat stroke

Purkinje cells. ***Purkinje cells*** - **Purkinje cells** in the cerebellum are particularly vulnerable to **hyperthermia** due to their high metabolic rate and sensitivity to oxidative stress. - Consistent changes, including **necrosis** and **apoptosis**, are often observed in these cells during heat stroke. *Hippocampus* - While the **hippocampus** can be affected in severe heat stroke, showing neuronal damage, it is **not as consistently or uniquely vulnerable** as Purkinje cells. - Damage to the hippocampus is often associated with more generalized **hypoxic-ischemic injury** seen in severe cases. *Midbrain* - The **midbrain** is part of the brainstem and primarily responsible for functions like motor control, vision, and hearing, and typically shows **less consistent or specific damage** in heat stroke compared to Purkinje cells. - Injury to the midbrain during heat stroke is usually a consequence of **widespread cerebral edema** or global anoxia, rather than a primary effect of hyperthermia. *Cerebral cortex* - Damage to the **cerebral cortex** in heat stroke can occur, leading to cognitive dysfunction and seizures, but it is **not as consistently affected** across all cases as Purkinje cells. - Cortical damage is more often linked to severe and prolonged hyperthermia or secondary complications like **cerebral edema**.

Question 1

Most common supratentorial tumor in children

Accepted Answer

Craniopharyngioma

Answer

Astrocytoma

Answer

Oligodendroglioma

Answer

Meningioma

Question 2

The site of occurrence of Subependymal Giant Cell Astrocytoma is

Accepted Answer

Foramen of Monro

Answer

Medulla Oblongata

Answer

Cerebellum

Answer

Pineal gland

Question 3

Schwannoma arises most frequently from:

Accepted Answer

Vestibular Nerve

Answer

Trigeminal nerve

Answer

Facial Nerve

Answer

Cochlear Nerve

Question 4

Which of the following statements about rabies is true?

Accepted Answer

Intracytoplasmic eosinophilic inclusion bodies are seen in brain cells

Answer

Presence of meningitis suggests against the diagnosis of rabies

Answer

Convulsions are generally not seen in a patient with rabies

Answer

Incubation period is approximately 20 to 80 days

Question 5

Which of the following is the most frequent primary malignant tumor of the CNS?

Accepted Answer

Glioblastoma multiforme

Answer

Oligodendroglioma

Answer

Medulloblastoma

Answer

Meningioma

Question 6

Lumbar puncture was done in a patient with raised intracranial tension. The patient died suddenly on the table. The cause of the death is most likely to be

Accepted Answer

Tentorial herniation

Answer

Rupture of an aneurysm

Answer

Middle cerebral artery hemorrhage

Answer

Loss of CSF

Question 7

Porencephaly refers to -

Accepted Answer

Vascular lesions due to degenerative vessel disease and head injury

Answer

Neural tube defects

Answer

Fetal alcohol syndrome

Answer

Dandy-Walker syndrome

Question 8

The characteristic feature of Lhermitte-Duclos disease is:

Accepted Answer

Thickened cerebellar folia

Answer

Atrophic cerebellar folia

Answer

Septum pellucidum agenesis

Answer

Vermian hypoplasia

Question 9

False regarding Alzheimer's disease (AD) is:

Accepted Answer

Extracellular inclusion (lesion) can occur in the absence of intracellular inclusions to make pathological diagnosis of AD

Answer

Number of neurofibrillary tangles is associated with the severity of dementia

Answer

Number of senile (neuritic) plaques correlates (increases) with age

Answer

Presence of tau protein suggest neurodegeneration

Question 10

Which part of brain shows consistent changes in heat stroke

Accepted Answer

Purkinje cells

Answer

Hippocampus

Answer

Midbrain

Answer

Cerebral cortex

Neuropathology — MCQs

Neuropathology — MCQs

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