Neuropathology Practice Questions

Q: Suprasellar cystic mass in children is –

Craniopharyngioma. ***Craniopharyngioma*** - **Craniopharyngiomas** are the most common suprasellar tumors in children and are frequently **cystic with calcifications**, making them a prime consideration for a suprasellar cystic mass. - They arise from remnants of Rathke's pouch and often present with symptoms related to **pituitary hormone deficiencies** and **visual field defects** due to compression of the optic chiasm. *Medulloblastoma* - **Medulloblastomas** are typically located in the **posterior fossa** (cerebellum) of children, not the suprasellar region. - They are usually **solid, highly malignant tumors** and do not characteristically present as cystic suprasellar masses. *Secondaries* - **Metastatic tumors (secondaries)** to the brain, particularly to the suprasellar region, are **rare in children** and typically present as solid masses, not primarily cystic. - When they do occur, they usually originate from primary cancers like leukemia or sarcoma, which would have other systemic manifestations. *Meningioma* - **Meningiomas** are tumors that arise from the **meninges**, most commonly in adults, and while they can occur near the sella, they are typically **solid, dural-based tumors** and are very rare in children. - They do not usually present as a primary cystic suprasellar mass.

Q: Which part of spinal cord is involved in poliomyelitis?

Anterior horn. ***Anterior horn*** - Poliomyelitis specifically targets and destroys the **motor neurons** located in the **anterior horns** of the spinal cord [1]. - Damage to these motor neurons leads to characteristic **flaccid paralysis** and muscle weakness [1]. *Posterior column* - The posterior column is primarily responsible for **fine touch**, **vibration**, and **proprioception**. - While it can be affected in some neurological conditions, it is **not the primary site of damage** in poliomyelitis. *Lateral column* - The lateral column contains descending motor tracts like the **corticospinal tract**, responsible for **voluntary movement**, and ascending sensory tracts such as those for **pain and temperature**. - Although motor deficits occur in poliomyelitis, the primary lesion is in the motor neuron cell bodies, not the descending tracts within the lateral column. *Posterior horn* - The posterior horn mainly processes **sensory information** entering the spinal cord. - It is **not directly involved** in the pathogenesis of poliomyelitis, which primarily affects motor function. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 66-67.

Q: Loss of striatal fibres in caudate nucleus is associated with?

Huntington's disease. ***Huntington's disease*** - This neurodegenerative disorder is pathologically characterized by **atrophy of the striatum**, particularly the **caudate nucleus** [1]. - The loss of striatal neurons, especially medium spiny neurons, leads to the characteristic **chorea** and cognitive decline [1]. *Hemiballismus* - Characterized by **unilateral, violent, flinging movements** of the limbs. - It is typically caused by a lesion in the **subthalamic nucleus**, not the caudate nucleus. *Charcot-Marie-Tooth disease* - A group of inherited disorders that affect the **peripheral nerves**, leading to muscle weakness and sensory loss. - This condition does not involve the degeneration of the striatal fibers in the caudate nucleus. *Parkinson's disease* - Primarily caused by the degeneration of **dopaminergic neurons** in the **substantia nigra pars compacta**. - While it affects the basal ganglia circuitry, its primary pathology is not the loss of striatal fibers in the caudate nucleus but rather a **dopamine deficiency**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1299-1300.

Q: Which of the following is associated with bilateral eighth nerve neuromas?

Neurofibromatosis II. ***Neurofibromatosis II*** - **Bilateral vestibular schwannomas** (eighth nerve neuromas) are the hallmark diagnostic criterion for Neurofibromatosis type 2 (NF2) [1]. - NF2 is an **autosomal dominant** disorder caused by a mutation in the **NF2 gene** on chromosome 22. *Tuberous sclerosis* - This condition is characterized by **hamartomas** in multiple organs, including the brain, skin, kidneys, and heart. - It does not typically involve the formation of **eighth nerve neuromas**. *Neurofibromatosis I* - NF1 is primarily associated with **café-au-lait spots**, **cutaneous neurofibromas**, and **Lisch nodules**. - While NF1 can lead to various neurological tumors, **bilateral eighth nerve neuromas** are not a characteristic feature; unilateral vestibular schwannomas can rarely occur but are much more common in NF2 [1]. *All of the options* - Only **Neurofibromatosis II** is specifically associated with bilateral eighth nerve neuromas as a defining feature. - Tuberous Sclerosis and Neurofibromatosis I do not typically present with this finding.

Q: Fluid-filled cavity at the center of the spinal cord is seen in:

Syringomyelia. ***Syringomyelia*** - **Syringomyelia** is characterized by the formation of a **syrinx**, a fluid-filled cavity or cyst, within the spinal cord, most commonly in the cervical region - This cavity expands over time, compressing and damaging nerve fibers from the inside out, leading to progressive neurological deficits - Classic presentation includes **dissociated sensory loss** (loss of pain and temperature sensation with preserved touch and proprioception) in a "cape-like" distribution *Subacute combined degeneration (SACD) of cord* - SACD is primarily caused by **Vitamin B12 deficiency** and involves demyelination of the **dorsal and lateral columns** of the spinal cord [1] - Does not present with a fluid-filled cavity but rather with neuronal degeneration and demyelination [1] - Clinical features include both sensory ataxia (dorsal column) and spastic paraparesis (lateral corticospinal tract) [2] *Brown Sequard syndrome* - Results from **hemitransection (damage to one side)** of the spinal cord, typically from trauma or mass lesions - Leads to ipsilateral motor paralysis and loss of proprioception, with contralateral loss of pain and temperature sensation - Involves damage to specific tracts rather than formation of a central cavity *Tabes dorsalis* - **Tabes dorsalis** is a late manifestation of **tertiary syphilis**, causing degeneration of the **dorsal columns** and dorsal nerve roots - Characterized by sensory ataxia, lightning pains, Argyll Robertson pupils, and Charcot joints - Does not involve a fluid-filled cavity but rather progressive demyelination **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 716-717. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1306-1307.

Q: Which brain tumor has the worst prognosis in children?

Brainstem glioma. ***Brainstem glioma*** - **Diffuse intrinsic pontine gliomas (DIPG)** are particularly aggressive, typically unresponsive to conventional therapies, and have a median survival of less than one year. - Their critical location in the **brainstem** makes surgical resection extremely difficult and often impossible without causing severe neurological deficits [2]. *Craniopharyngioma* - While they can be challenging to treat due to their proximity to vital structures like the **optic chiasm** and **hypothalamus**, they are generally benign and have a good prognosis with complete surgical resection. - They tend to recur if not completely removed, but recurrence is often amenable to further treatment. *Cerebellar astrocytoma* - These are often **low-grade (pilocytic astrocytomas)** and have an excellent prognosis, especially if surgical gross total resection is achieved [2]. - They are usually cystic and well-demarcated, making them more amenable to curative surgical removal. *Pineal body tumor* - The prognosis of pineal region tumors varies greatly depending on the **histology** (e.g., germinoma, pineoblastoma, pineocytoma) [1]. - While some are aggressive (like pineoblastomas), a significant portion, such as germinomas, are highly sensitive to **radiation therapy** and have a relatively good prognosis [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Endocrine System, pp. 1140-1141. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1319-1320.

Q: All of the following statements about cerebellar astrocytomas in paediatric age group are true, EXCEPT:

These tumours are more common in females. ***These tumours are more common in females*** - Cerebellar astrocytomas, particularly **pilocytic astrocytomas (PA)**, show a slight male predominance [1], or equal sex distribution, rather than being more common in females. - This statement is the exception to the generally true characteristics of cerebellar astrocytomas in children. *These tumors have a good prognosis* - **Pilocytic astrocytomas (PAs)**, which constitute the majority of pediatric cerebellar astrocytomas, are generally **low-grade (WHO grade I)** tumors. - They have an **excellent prognosis** following gross total resection, with high 5-year survival rates. *These are usually Low grade tumors* - The vast majority of cerebellar astrocytomas in children are **pilocytic astrocytomas**, which are classified as **WHO grade I** [2]. - This low-grade nature contributes significantly to their favorable prognosis compared to higher-grade astrocytomas. *These are more commonly seen in the 1st and 2nd decades* - Pediatric cerebellar astrocytomas primarily affect **children and young adults**, with the peak incidence observed in the **first two decades of life** [1], [2]. - They are among the most common brain tumors in this age group, typically presenting between the ages of 5 and 15 years. **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: All of the following are morphological neurological complications of measles except

Optic neuritis. ***Optic neuritis*** - **Optic neuritis** is not considered a typical *morphological* neurological complication directly caused by measles virus infection itself. - While visual disturbances can occur with CNS complications, **optic neuritis** itself is more commonly associated with demyelinating diseases like **multiple sclerosis** [1]. *SSPE* - **Subacute sclerosing panencephalitis (SSPE)** is a rare but devastating *morphological* neurological complication of measles, caused by a persistent measles virus infection in the brain [2]. - It leads to progressive **neurodegeneration** with characteristic inclusion bodies and gliosis. *Encephalitis* - **Measles encephalitis** is an acute *morphological* inflammation of the brain parenchyma, which can be either directly viral or post-infectious (acute disseminated encephalomyelitis - ADEM) [1]. - It often presents with seizures, altered consciousness, and focal neurological deficits, indicating structural brain involvement. *Transverse myelitis* - **Transverse myelitis** is a recognized *morphological* neurological complication following measles, characterized by inflammation across one section of the **spinal cord** [1]. - This leads to motor weakness, sensory loss, and autonomic dysfunction below the level of the lesion.

Q: Xanthochromia of CSF is seen in all except:

Bloody tap. ***Bloody tap*** - A bloody tap refers to the presence of blood from a **traumatic lumbar puncture**, which introduces fresh blood into the CSF. - This fresh blood would **not have had sufficient time to lyse** and release hemoglobin or oxyhemoglobin to cause xanthochromia. - Xanthochromia typically develops **2-12 hours after hemorrhage** as RBCs lyse and hemoglobin breaks down into bilirubin. *Subarachnoid hemorrhage* - **Subarachnoid hemorrhage (SAH)** is the **classic cause of xanthochromia**. - Following SAH, RBCs in the CSF undergo lysis, releasing **oxyhemoglobin** (peaks at 12-36 hours) and later **bilirubin** (peaks at 2-4 days). - Xanthochromia is detectable by **spectrophotometry** and helps distinguish SAH from traumatic tap. *Increased proteins* - **Elevated protein levels** (>150 mg/dL) in the CSF can cause yellowish discoloration. [1] - Seen in conditions like **Guillain-Barré syndrome** (albuminocytologic dissociation), **Froin's syndrome**, or tumors causing CSF obstruction. - The yellow color is due to protein concentration and binding properties. *Carotene* - **Severe carotenemia** (hypercarotenemia) from excessive intake of carotene-rich foods can rarely cause xanthochromia. - Carotene is a **lipophilic pigment** that can cross into CSF and impart a yellow color. - This is an uncommon but documented cause. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1275-1276.

Question 1

Suprasellar cystic mass in children is –

Accepted Answer

Craniopharyngioma

Answer

Medulloblastoma

Answer

Secondaries

Answer

Meningioma

Question 2

Which part of spinal cord is involved in poliomyelitis?

Accepted Answer

Anterior horn

Answer

Posterior column

Answer

Lateral column

Answer

Posterior horn

Question 3

Loss of striatal fibres in caudate nucleus is associated with?

Accepted Answer

Huntington's disease

Answer

Hemiballismus

Answer

Charcot-Marie-Tooth disease

Answer

Parkinson's disease

Question 4

Which of the following is associated with bilateral eighth nerve neuromas?

Accepted Answer

Neurofibromatosis II

Answer

Tuberous sclerosis

Answer

Neurofibromatosis I

Answer

All of the options

Question 5

Fluid-filled cavity at the center of the spinal cord is seen in:

Accepted Answer

Syringomyelia

Answer

Subacute combined degeneration (SACD) of cord

Answer

Brown Sequard syndrome

Answer

Tabes dorsalis

Question 6

Which brain tumor has the worst prognosis in children?

Accepted Answer

Brainstem glioma

Answer

Craniopharyngioma

Answer

Cerebellar astrocytoma

Answer

Pineal body tumor

Question 7

All of the following statements about cerebellar astrocytomas in paediatric age group are true, EXCEPT:

Accepted Answer

These tumours are more common in females

Answer

These tumors have a good prognosis

Answer

These are usually Low grade tumors

Answer

These are more commonly seen in the 1st and 2nd decades

Question 8

All of the following are morphological neurological complications of measles except

Accepted Answer

Optic neuritis

Answer

SSPE

Answer

Encephalitis

Answer

Transverse myelitis

Question 9

Which of the following most likely causes a communicating (nonobstructive) hydrocephalus?

Accepted Answer

Blockage of the arachnoid granulations

Answer

Tuberculous meningitis

Answer

Stenosis of the duct of Sylvius

Answer

Ependymoma of the fourth ventricle

Question 10

Xanthochromia of CSF is seen in all except:

Accepted Answer

Bloody tap

Answer

Increased proteins

Answer

Carotene

Answer

Subarachnoid hemorrhage

Neuropathology — MCQs

Neuropathology — MCQs

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