Neuropathology Practice Questions

Q: Which of the following statements about metastases of malignant tumors of the brain is TRUE?

All of the above.. Primary malignant brain tumors (like Medulloblastoma or Glioblastoma) rarely metastasize outside the CNS because the brain lacks a traditional lymphatic system and is protected by the blood-brain barrier. However, spread can occur through specific pathways. [1] **Explanation of Options:** * **Option A (Drop Metastases):** Tumors arising near the ventricles or subarachnoid space (e.g., Medulloblastoma, Ependymoma) can shed cells into the Cerebrospinal Fluid (CSF). Gravity carries these cells to the lower spinal cord (cauda equina), forming "drop metastases." [1] * **Option B (Lymph Node Metastases):** While the brain lacks lymphatics, surgery or trauma can disrupt the blood-brain barrier and create a communication between the tumor and extracranial tissues. This allows tumor cells to reach systemic lymphatics, leading to regional lymph node involvement. * **Option C (Man-made Shunts):** Ventriculoperitoneal (VP) shunts, used to treat hydrocephalus, provide a physical conduit for tumor cells. Cells can travel through the tubing and seed the peritoneal cavity (extracranial spread). **Conclusion:** Since all three mechanisms are recognized pathways for the spread of malignant CNS tumors, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Medulloblastoma** is the most common tumor to show "drop metastases" to the spinal cord. [1] * **Glioblastoma Multiforme (GBM)** is the most common primary brain tumor to show extracranial spread (usually after surgery). * **Systemic metastasis** of primary CNS tumors is extremely rare (<1%) due to the rapid clinical course and anatomical barriers. **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: The given lesion is best associated with which of the following conditions?

Atherosclerotic (ischemic) stroke. ***Atherosclerotic (ischemic) stroke*** • The large **cystic cavity** with **liquefactive necrosis** in the **MCA territory** is characteristic of a chronic atherosclerotic infarct where necrotic tissue has been cleared. • **Single-territory involvement** and the **well-demarcated** nature of the lesion strongly suggest **thrombotic occlusion** of a major cerebral artery due to atherosclerosis. *Embolic stroke* • Typically produces **multiple small infarcts** scattered across different vascular territories rather than a single large cavity. • Often shows **hemorrhagic transformation** with petechial bleeding, which is not evident in this purely cystic lesion. *Hypertensive bleed* • Usually occurs in the **basal ganglia**, **thalamus**, or **brainstem** due to rupture of small penetrating arteries. • Presents as **acute hemorrhage** with blood clot formation, not as a **cystic cavity** with liquefactive necrosis. *Ruptured berry aneurysm* • Causes **subarachnoid hemorrhage** with blood in the **subarachnoid space** around the brain surface. • Does not typically produce **parenchymal cystic cavities** but rather results in **acute bleeding** into CSF spaces.

Question 1

Which one of the following brain tumors is highly vascular in nature?

Accepted Answer

Meningiomas

Answer

Glioblastoma

Answer

CPA epidermoid tumor

Answer

Pituitary adenomas

Question 2

All of the following are true regarding primary CNS lymphoma, except:

Accepted Answer

Anaplastic large cell lymphomas are the most common histologic group.

Answer

Most primary brain lymphomas are of B-cell origin.

Answer

Hooping is characteristic of primary brain lymphoma.

Answer

Primary lymphomas of the CNS are aggressive.

Question 3

Multiple cystic lesions are seen in the muscle and brain of a 16-year-old boy who died of status epilepticus. What is the most likely diagnosis?

Accepted Answer

Neurocysticercosis

Answer

Cerebral amebiasis

Answer

Neurosarcoidosis

Answer

CNS toxoplasmosis

Question 4

Lewy bodies contain which of the following?

Accepted Answer

a-synuclein

Answer

Tirofiban

Answer

Melanin

Answer

Amyloid

Question 5

Aggregates of 'tau protein' seen in the Hippocampus of an elderly man are indicative of which of the following?

Accepted Answer

Neurofibrillary tangles

Answer

Miculicz cells

Answer

Senile plaques

Answer

Alcoholic/ Mallory hyaline bodies

Question 6

Which of the following tumors is associated with drop metastasis?

Accepted Answer

Medulloblastoma

Answer

Astrocytoma

Answer

Ependymoma

Answer

Oligodendroglioma

Question 7

Foix-Alajouanine disease of the spinal cord is a:

Accepted Answer

Arteriovenous malformation

Answer

Cavernous malformation

Answer

Capillary telangiectasia

Answer

Venous angioma

Question 8

Which of the following statements about metastases of malignant tumors of the brain is TRUE?

Accepted Answer

All of the above.

Answer

Drop metastases can occur in the spinal cord.

Answer

Lymph node metastases can occur in patients who have undergone brain surgery.

Answer

Metastases can occur through man-made shunts.

Question 9

Which among the following is the commonest type of intracranial tumour?

Accepted Answer

Secondaries

Answer

Astrocytoma

Answer

Medulloblastoma

Answer

Meningioma

Question 10

The given lesion is best associated with which of the following conditions?

Accepted Answer

Atherosclerotic (ischemic) stroke

Answer

Embolic stroke

Answer

Hypertensive bleed

Answer

Ruptured berry aneurysm

Neuropathology — MCQs

Neuropathology — MCQs

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