Neuropathology Practice Questions

Q: Which of the following is most likely to be seen due to the rupture of a saccular aneurysm?

Subarachnoid hemorrhage. ***Subarachnoid hemorrhage*** - A **saccular aneurysm** (often a **berry aneurysm**) commonly ruptures into the **subarachnoid space**, causing bleeding around the brain [2]. - This leads to a sudden onset of a "thunderclap headache," **meningeal irritation**, and neurological deficits [1]. *Subdural hemorrhage* - A **subdural hemorrhage** is typically caused by the tearing of **bridging veins** between the dura and arachnoid mater, often due to **trauma** [3]. - While it can occur, it is a less common direct consequence of saccular aneurysm rupture compared to subarachnoid hemorrhage. *Intracerebral hemorrhage* - An **intracerebral hemorrhage** involves bleeding directly into the brain parenchyma, most often due to **hypertension** or **amyloid angiopathy**. - Although a ruptured aneurysm can rarely extend into the brain tissue, the primary initial bleeding is usually into the subarachnspace [4]. *Hydrocephalus* - **Hydrocephalus** can be a *complication* of a subarachnoid hemorrhage, resulting from impaired CSF reabsorption or obstruction of CSF flow due to blood clots. - However, it is not the *initial event* caused directly by the rupture of a saccular aneurysm [4].

Q: A 20-year-old man presented with a complaint of a swelling of the wrist for the last two years. Histopathological examination showed spindle-shaped cells and Verocay bodies. What is the diagnosis?

Schwannoma. ***Schwannoma*** - Characterized by the presence of **spindle-shaped cells** and **Verocay bodies**, typical of schwannomas, which are tumors of peripheral nerve sheath origin [1,3]. - Commonly presents with **pain** and **local swelling** in affected areas, aligning with the patient's symptoms [2]. *Dermoid cyst* - Usually presents as a **cystic lesion** containing skin appendages but does not feature spindle-shaped cells. - Lacks the characteristic **Verocay bodies**, which help differentiate schwannomas [1]. *Lipoma* - Composed of **mature adipocytes**, presenting as soft, movable masses, but not associated with spindle-shaped cells. - Histopathological examination would not reveal **Verocay bodies**, making it distinct from schwannoma [1]. *Neurofibroma* - Typically associated with **plexiform growth patterns** and lacks the classic **Verocay bodies** seen in schwannomas [1]. - Often occurs in patients with **neurofibromatosis** and presents differently than the clinical scenario here [3]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, p. 1250. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 727-728. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1248-1249.

Q: What are Gitter cells?

Modified macrophages in the CNS. ***Modified macrophages in CNS*** - Gitter cells are **modified macrophages** that have phagocytized lipid and other debris in the central nervous system (CNS), particularly in response to injury or disease [1][2]. - They play a crucial role in **cleaning up cellular debris** and are involved in the inflammatory response within the CNS [2]. *Macroglia* - Macroglia refers to **supportive cells** in the CNS, including astrocytes and oligodendrocytes, rather than being specifically modified macrophages. - It does not specifically describe the **phagocytic role** characteristic of Gitter cells. *Oligodendrocytes* - Oligodendrocytes primarily function to **myelinate axons** in the CNS and do not possess the same phagocytic capabilities as Gitter cells. - They are involved in **insulation** of neuronal axons rather than debris clearance. *Astrocytes* - Astrocytes are the principal **supportive glial cells** in the CNS and do not exhibit the characteristics of Gitter cells. - Their functions include **maintaining blood-brain barrier**, regulating blood flow, and supporting neuronal metabolism, not phagocytosis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1255-1256. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 697-698.

Q: Which receptors are blocked in Myasthenia Gravis?

ACh receptors. ***Ach receptors*** - Myasthenia Gravis is an **autoimmune disease** where **antibodies** block, alter, or destroy the **nicotinic acetylcholine receptors** at the **neuromuscular junction** [1], [2]. - This blockage prevents **acetylcholine** from binding to the receptors, leading to impaired muscle contraction and **muscle weakness** [1]. *Ca++ receptors* - **Calcium channels** (not "receptors" in this context) are involved in the release of **acetylcholine** from the presynaptic terminal, but they are not the primary target in Myasthenia Gravis [1]. - While calcium influx is crucial for neurotransmitter release, the problem in Myasthenia Gravis lies postsynaptically, at the **acetylcholine receptor** [2]. *Na+ receptors* - **Sodium channels** are essential for generating and propagating **action potentials** in muscle fibers after acetylcholine binds and opens the acetylcholine receptor. - They are not directly targeted by autoantibodies in Myasthenia Gravis; the issue occurs upstream, preventing the initial depolarization signal [2]. *Opioid receptors* - **Opioid receptors** are involved in pain modulation and other central nervous system functions, primarily binding endorphins and exogenous opioids. - They have no role in the pathophysiology of Myasthenia Gravis, which is a disorder of the **neuromuscular junction** [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 213-214. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1237-1239.

Q: Plaques jaunes are seen in which condition?

Atherosclerosis. ***Head injury*** - **Plaques jaunes**, or yellow plaques, are primarily associated with brain injuries, particularly in areas of **contusion** or **hemorrhage** [1]. - These plaques may represent **lipid-laden macrophages** and indicate areas of *necrosis* and inflammation in the brain [1]. *Endocarditis* - Endocarditis is characterized by **vegetations** on heart valves rather than plaques in the brain. - Symptoms typically include **fever**, **murmurs**, and **embolization**, which do not involve yellow plaques. *Syphilis* - Syphilis may cause *gummatous lesions* but is not associated with yellow plaques in the brain. - Typical findings include **rash** and **ulcerative lesions**, particularly during the secondary stage. *Atherosclerosis* - Atherosclerosis involves **plaque formation** in blood vessels but these are not the same as **plaques jaunes** in neurological contexts. - It is characterized by **cholesterol** deposits and plaque rupture leading to cardiovascular events, not plaques seen in head injuries. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1262-1264.

Q: Most common site of hypertensive intraparenchymal hemorrhage in the brain?

Putamen. ***Putamen*** - The **putamen** is the most frequent site for **hypertensive intraparenchymal hemorrhages** [1] due to the presence of numerous small, thin-walled arterioles (lenticulostriate arteries) that are highly susceptible to damage from chronic hypertension [1]. - Hemorrhages in this region often cause **contralateral hemiparesis**, **hemianesthesia**, and **gaze deviation** towards the side of the lesion due to involvement of nearby motor and sensory pathways [1]. *Thalamus* - While the **thalamus** is a common site for hypertensive hemorrhages, it is less common than the putamen [1], [2]. - Thalamic hemorrhages typically cause **contralateral sensory loss**, **oculomotor dysfunction**, and sometimes **aphasia** if the dominant hemisphere is affected. *Cerebellum* - **Cerebellar hemorrhages** are less frequent than those in the basal ganglia or thalamus [1]. - Symptoms usually include **ataxia**, **nystagmus**, vomiting, and potential brainstem compression if large. *Pons* - **Pontine hemorrhages** are among the most severe and are often rapidly fatal due to damage to vital brainstem structures [1], [2]. - They typically present with **coma**, **quadriparesis**, **pinpoint pupils**, and rapid progression to respiratory arrest.

Q: Which of the following brain tumors is considered the most aggressive and has the worst prognosis?

Glioblastoma Multiforme. ***Glioblastoma Multiforme*** - This is a **Grade IV astrocytoma** and is the most common and most aggressive primary brain tumor in adults [1]. - It is characterized by rapid growth, a highly **infiltrative nature**, and poor response to treatment, leading to a very short median survival [1]. *Meningioma* - These are typically **benign (Grade I)** tumors originating from the meninges, accounting for about one-third of all primary brain tumors [2]. - While they can cause symptoms due to mass effect, they usually have a **slow growth rate** and a good prognosis after surgical resection [2]. *Anaplastic astrocytoma* - This is a **Grade III astrocytoma**, which is malignant but generally less aggressive than glioblastoma multiforme (Grade IV) [1]. - It shows **increased cellularity**, nuclear atypia, and mitotic figures, but lacks the microvascular proliferation and necrosis characteristic of glioblastoma [1]. *Primary CNS lymphoma* - This is a **rare non-Hodgkin lymphoma** that primarily affects the brain, spinal cord, or eyes. - While aggressive, it often responds to **chemotherapy** and radiation, making its prognosis generally better than that of glioblastoma, particularly in immunocompetent patients. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1310-1311. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1316-1317.

Q: Medulloblastoma arises exclusively from the cells of

Immature embryonal cells. ***Immature embryonal cells*** - **Medulloblastoma** is a malignant **embryonal tumor** of the cerebellum, exclusively arising from primitive neuroectodermal cells. - These tumors are thought to originate from remnants of the **external granular layer** of the cerebellum or other primitive neuroectodermal cells. *Ependymal cells* - Tumors arising from **ependymal cells** are called **ependymomas**, which typically occur within the ventricles of the brain or spinal cord. - Ependymomas have distinct histological features and clinical behavior compared to medulloblastomas. *Neurons* - Tumors primarily composed of neurons or with significant neuronal differentiation include **gangliogliomas** and **central neurocytomas**. - **Medulloblastomas** largely consist of undifferentiated, small round cells with minimal evidence of neuronal maturation. *Spindle-shaped cells* - **Spindle-shaped cells** are characteristic of various tumor types, including some **gliomas** (e.g., pilocytic astrocytoma) or mesenchymal tumors. - While some medulloblastoma variants can show desmoplastic features, the hallmark cell type is a small, round, blue embryonal cell.

Q: Alzheimer type II astrocytes are seen in which condition?

Hepatic encephalopathy. ***Hepatic encephalopathy*** - **Alzheimer type II astrocytes** are characteristic histological findings in cases of **hepatic encephalopathy**, reflecting the brain's response to elevated ammonia levels. - These astrocytes show enlarged, pale nuclei with prominent nucleoli and marginal chromatin, indicating cellular stress from metabolic dysfunction in the setting of liver failure. *Alzheimer's* - Alzheimer's disease is characterized by the presence of **neurofibrillary tangles** (tau protein) and **amyloid plaques** (beta-amyloid protein), not Alzheimer type II astrocytes. - Astrocytes in Alzheimer's disease may show reactive changes, but they do not typically manifest as the specific "Alzheimer type II" morphology. *Parkinsonism* - Parkinsonism is primarily characterized by the degeneration of **dopaminergic neurons** in the substantia nigra and the presence of **Lewy bodies** (alpha-synuclein aggregates). - While glial cells (astrocytes and microglia) do play a role in neuroinflammation in Parkinson's, they do not exhibit the specific Alzheimer type II astrocytic change. *Binswanger disease* - Binswanger disease is a form of **vascular dementia** characterized by diffuse white matter lesions due to chronic ischemia and damage to small cerebral blood vessels. - The pathology primarily involves demyelination and axonal loss in the white matter, with reactive gliosis, but not the specific changes seen in Alzheimer type II astrocytes.

Q: What is the first cellular response observed after a sharp nerve cut?

Chromatolysis. ***Chromatolysis*** - **Chromatolysis** is the dissolution of the Nissl bodies (rough endoplasmic reticulum) in the neuron cell body following axonal injury, which is the **first observable cellular response** [1]. - This process is a preparatory step for neuronal regeneration, indicating the cell's attempt to repair the damaged axon [1]. *Polymorphic arrangement* - This term is not typically used to describe an immediate cellular response to a nerve cut; it might refer to diverse cell shapes or arrangements in different contexts but is not a recognized initial post-injury event. - The neuron's immediate response involves changes within the cell body, not a re-arrangement of its cellular structure with other cells. *Increased protein synthesis* - While increased protein synthesis does occur during neuronal repair and regeneration, it is a consequence of chromatolysis and part of a later, more sustained response, not the very first visible cellular change [1]. - **Chromatolysis precedes** and facilitates the subsequent increase in protein synthesis necessary for axonal regrowth [1]. *Macrophage activation* - **Macrophage activation** is a crucial part of the inflammatory response and debris clearance following nerve injury, but it is not the *first cellular response* of the neuron itself [2]. - Macrophages migrate to the site of injury hours to days after the initial insult, whereas chromatolysis begins within the neuron's cell body much earlier [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Peripheral Nerves and Skeletal Muscles, pp. 1254-1256. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 697-698.

Question 1

Which of the following is most likely to be seen due to the rupture of a saccular aneurysm?

Accepted Answer

Subarachnoid hemorrhage

Answer

Subdural hemorrhage

Answer

Intracerebral hemorrhage

Answer

Hydrocephalus

Question 2

A 20-year-old man presented with a complaint of a swelling of the wrist for the last two years. Histopathological examination showed spindle-shaped cells and Verocay bodies. What is the diagnosis?

Accepted Answer

Schwannoma

Answer

Lipoma

Answer

Dermoid cyst

Answer

Neurofibroma

Question 3

What are Gitter cells?

Accepted Answer

Modified macrophages in the CNS

Answer

Microglia

Answer

Astrocytic cells

Answer

Oligodendrocytic cells

Question 4

Which receptors are blocked in Myasthenia Gravis?

Accepted Answer

ACh receptors

Answer

Opioid receptors

Answer

Na+ receptors

Answer

Ca++ receptors

Question 5

Plaques jaunes are seen in which condition?

Accepted Answer

Atherosclerosis

Answer

Syphilis

Answer

Head injury

Answer

Endocarditis

Question 6

Most common site of hypertensive intraparenchymal hemorrhage in the brain?

Accepted Answer

Putamen

Answer

Thalamus

Answer

Cerebellum

Answer

Pons

Question 7

Which of the following brain tumors is considered the most aggressive and has the worst prognosis?

Accepted Answer

Glioblastoma Multiforme

Answer

Meningioma

Answer

Primary CNS lymphoma

Answer

Anaplastic astrocytoma

Question 8

Medulloblastoma arises exclusively from the cells of

Accepted Answer

Immature embryonal cells

Answer

Ependymal cells

Answer

Neurons

Answer

Spindle-shaped cells

Question 9

Alzheimer type II astrocytes are seen in which condition?

Accepted Answer

Hepatic encephalopathy

Answer

Parkinsonism

Answer

Alzheimer's

Answer

Binswanger disease

Question 10

What is the first cellular response observed after a sharp nerve cut?

Accepted Answer

Chromatolysis

Answer

Polymorphic arrangement

Answer

Increased protein synthesis

Answer

Macrophage activation

Neuropathology — MCQs

Neuropathology — MCQs

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