Neuropathology Practice Questions

Q: A 45-year-old patient presented with neurological deficits and seizures. Imaging showed a lesion in the temporal lobe. Biopsy of the lesion was taken for histological examination. Based on the characteristic histological features, what is the most likely diagnosis?

Oligodendroglioma. ***Oligodendroglioma*** - Classic **"fried egg"** histological appearance with **perinuclear halos** and **"chicken wire" capillary pattern** are pathognomonic features of oligodendroglioma. - Commonly presents in **adults** with **seizures** and preferentially affects the **temporal lobe**, making it consistent with this clinical presentation. *Glioblastoma* - Shows **pseudopalisading necrosis** and **microvascular proliferation** with highly pleomorphic cells, not the uniform "fried egg" appearance. - Typically presents as a **rapidly growing** mass with **ring enhancement** on imaging, often in older patients (>50 years). *Pilocytic astrocytoma* - Characterized by **Rosenthal fibers** and **eosinophilic granular bodies** with biphasic architecture of loose and compact areas. - More common in **children and young adults**, typically located in the **cerebellum** or **optic pathway**, not temporal lobe. *Medulloblastoma* - Shows **small blue round cells** with high **mitotic activity** and **Homer Wright rosettes** in densely packed sheets. - Exclusively occurs in the **posterior fossa** (cerebellum/brainstem) and is primarily a **pediatric tumor**, not temporal lobe lesions in adults.

Q: Neurodegeneration with iron accumulation in basal ganglia is typically seen in which condition?

Hallervorden-Spatz disease. **Explanation:** **1. Why Hallervorden-Spatz Disease is Correct:** Hallervorden-Spatz disease, now more commonly known as **Pantothenate Kinase-Associated Neurodegeneration (PKAN)**, is a rare autosomal recessive neurodegenerative disorder caused by mutations in the *PANK2* gene. This defect leads to an abnormal accumulation of **iron** in the brain, specifically within the **globus pallidus** and **substantia nigra pars reticulata**. On T2-weighted MRI, this iron deposition creates a pathognomonic sign known as the **"Eye of the Tiger" sign** (a central area of hyperintensity surrounded by a rim of hypointensity). **2. Why the Other Options are Incorrect:** * **Hemochromatosis:** This is a systemic iron overload disorder. While iron accumulates in the liver, heart, and endocrine organs, it typically **spares the brain** due to the blood-brain barrier. * **Wilson’s Disease:** This is a disorder of **copper** metabolism, not iron. While it involves the basal ganglia (specifically the putamen), the primary pathology is copper toxicity leading to gliosis and cavitation. * **Cystic Fibrosis:** This is a multi-system disorder affecting chloride channels (CFTR gene), primarily impacting the lungs and pancreas. It has no association with iron accumulation in the basal ganglia. **3. NEET-PG High-Yield Pearls:** * **MRI Finding:** Look for the "Eye of the Tiger" sign in clinical vignettes. * **Genetics:** Autosomal Recessive; *PANK2* gene mutation on Chromosome 20p. * **Histology:** Presence of **Spheroid bodies** (swollen axonal terminals) and iron-containing pigment (neuromelanin and lipofuscin). * **Clinical Presentation:** Extrapyramidal symptoms like dystonia, parkinsonism, and choreoathetosis, usually beginning in childhood.

Q: What is the most common primary brain tumor in adults?

Astrocytoma. **Explanation:** **Astrocytoma** is the correct answer because it represents the most common group of primary intracranial neoplasms in adults [1]. Specifically, **Glioblastoma (GBM)**, which is a Grade IV astrocytoma, is the most frequent and aggressive primary malignant brain tumor in the adult population [1], [2]. Astrocytomas originate from astrocytes, the star-shaped glial cells that support neuronal function. **Analysis of Options:** * **B. Oligodendroglioma:** These are less common than astrocytomas. They typically present in middle-aged adults (30–50 years) and are characterized histologically by a "fried-egg" appearance and "chicken-wire" vascularity. * **C. Ependymoma:** While these can occur in adults (often in the spinal cord), they are much more common in children, typically arising in the fourth ventricle. * **D. Medulloblastoma:** This is a highly malignant Grade IV tumor, but it is primarily a **pediatric tumor** (the most common malignant brain tumor in children), occurring in the cerebellum [1]. It is rare in adults. **High-Yield Clinical Pearls for NEET-PG:** * **Most common brain tumor in adults (overall):** Metastatic tumors (Lung > Breast > Melanoma). * **Most common primary brain tumor in adults:** Astrocytoma (specifically Glioblastoma) [1]. * **Most common benign brain tumor in adults:** Meningioma (often associated with Psammoma bodies). * **Glioblastoma Marker:** GFAP (Glial Fibrillary Acidic Protein) positive. * **Radiology:** Glioblastoma typically shows a "butterfly glioma" pattern crossing the corpus callosum with ring enhancement on MRI [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. 1308-1310.

Question 1

A 45-year-old patient presented with neurological deficits and seizures. Imaging showed a lesion in the temporal lobe. Biopsy of the lesion was taken for histological examination. Based on the characteristic histological features, what is the most likely diagnosis?

Accepted Answer

Oligodendroglioma

Answer

Glioblastoma

Answer

Pilocytic astrocytoma

Answer

Medulloblastoma

Question 2

Neurofibrillary tangles are a deposition of which of the following substances?

Accepted Answer

Tau protein

Answer

Amyloid-beta peptide

Answer

Lewy bodies

Answer

Hirano bodies

Question 3

Neurodegeneration with iron accumulation in basal ganglia is typically seen in which condition?

Accepted Answer

Hallervorden-Spatz disease

Answer

Hemochromatosis

Answer

Wilson's disease

Answer

Cystic fibrosis

Question 4

What is the most common primary brain tumor in adults?

Accepted Answer

Astrocytoma

Answer

Oligodendroglioma

Answer

Ependymoma

Answer

Medulloblastoma

Question 5

Rupture of Berry aneurysm causes which type of hemorrhage?

Accepted Answer

Subarachnoid hemorrhage

Answer

Extradural hemorrhage

Answer

Subdural hemorrhage

Answer

Intracerebral hemorrhage

Question 6

Small cystic lesions in the lenticular nucleus, thalamus, and internal capsule are most closely associated with what condition?

Accepted Answer

Hypertension

Answer

Embolism

Answer

A demyelinating disease

Answer

A genetic disease

Question 7

Which of the following statements is FALSE regarding Krabbe's disease?

Accepted Answer

Hyperdensity on T2 MRI image

Answer

Extensive involvement of deep white matter

Answer

Involvement of cerebellar white matter

Answer

Basal ganglia calcification in CT scan

Question 8

What is the most common type of pathological change seen in Rabies?

Accepted Answer

Brain stem encephalitis

Answer

Meningitis

Answer

Cranial arteritis

Answer

Ventriculitis

Question 9

What is a watershed infarct in the brain?

Accepted Answer

Occurs in the terminal portion of main arteries

Answer

Occurs in the proximal portion of main arteries

Answer

Occurs in the central portion of main arteries

Answer

None of the above

Question 10

A 12-year-old boy develops fever, accompanied by occasional headaches, malaise, fatigue, and nausea a month after being bitten by a dog. One day later, he experiences episodes of rigidity, hallucinations, breath-holding, and difficulty swallowing because of uncontrollable oral secretions. Considering this clinical presentation and the historical context of early rabies treatment attempts, which of the following histologic findings in the brain would be most likely present in a rabid animal?

Accepted Answer

Negri bodies

Answer

Multinucleate giant cells

Answer

Perivascular lymphocytes

Answer

Pseudocysts with bradyzoites

Neuropathology — MCQs

Neuropathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?