IDS

Question 1

A. Thick gelatinous exudate fi lls the basal cisterns B. Macrosection of the infundibulum shows massive granulomatous exudate in the subarachnoid space (Cresyl violet). C. Subarachnoid exudate shows lymphoplasmacytic infi ltrations, Langhans’-type multinucleated giant cells, and epithelioid cells, and areas of caseous necrosis (HE WHAT DSE?

Answer 1

TB

Question 2

WHAT CONDITION?

A. Mononuclear cell infi ltrations in the subarachnoid space and vascular wall.

B. Mononuclear cells and activated microglia invade the neurons (neuronophagia).

C. Residual glial nodule takes the place of destroyed neurons (Cresyl violet).

Answer 2

viral meningoencephalitides.

Question 3

WHAT STRUCTURE

Answer 3

Langhans’-type multinucleated giant cells

Question 4

WHAT CONDITION?

A. Motor neurons in the medulla are invaded by activated

microglia and mononuclear cells.

B. Loose glial nodule at the site of

disintegrated neurons (HE).

Answer 4

ACUTE POLIO

Question 5

WHAT CONDITION?

A. Lumbar spinal cord shows atrophy of one anterior horn (iron hematoxylin-picrofuchsin stain).

B. Depletion of motor neurons (cresyl violet).

Answer 5

CHRONIC POLIO

Question 6

WHAT CONDITION

A. Schematic drawing shows the distribution of the lesions in the fronto-orbital and temporal regions.

B. Perivascular hemorrhages in the subarachnoid space and cerebral cortex.

C. Neuronophagia.

D. Cortical necrosis (HE).

Answer 6

HSV ENCEPH

Question 7

WHAT CONDITION

A. Periventricular mononuclear cell infi ltration.

B. Intranuclear inclusion in a cytomegalic cell (HE).

Answer 7

CMV ENCEPH

Question 8

WHAT CONDITION

Microglial nodules with multinucleated giant cells (A) in the white matter (HE) and (B) brainstem (Holmes— H-E). C. Expression of HIV p24 antigen in cells of microglial nodule (immunostain).

Answer 8

HIV ENCEPH

Question 9

WHAT CONDITION

A. Macrosection from the cerebral hemisphere shows multiple focal losses of myelin (LFB-CV-stain).

B. Microscopic picture shows focal disintegration of myelin

and axons (Holmes stain)

Answer 9

HIV LEUKOENCEPH

Question 10

A 40-year-old man presented with progressive fl accid paraparesis and loss of deep tendon refl exes. After a 6-month clinical course, he died. Peripheral nerve from the lumbosacral plexus shows (A) focal lymphocytic infi ltrations and fi brosis (HE) and (B) myelin degeneration (LFB-CV).

Answer 10

HIV POLYNEUROPATHY

Question 11

Vascular mineralization in childhood __________

Answer 11

HIV

Question 12

Multifocal myelin losses in subcortical white matter (myelin stain). WHAT CONDITION?

Answer 12

PML

Question 13

At 10 years of age, he died.

A. EEG shows periodic bursts of high-voltage slow complexes.

B. Cerebral cortex shows perivascular cuffi ngs with lymphocytes and plasma cells and

(C) glial nodules (HE). White matter

shows (D) myelin loss (Weil stain), (E) diffuse astrogliosis (Holzer stain), and (F) intranuclear inclusion in oligodendroglia (Lendrum stain).

WHAT CONDITION?

Answer 13

SSPE

Question 14

WHAT CONDTION?

Answer 14

ASPERGILLOSIS

Question 15

WHAT ORGANISM?

Answer 15

D. Aspergillus hyphae fi ll the lumen and penetrate the wall of a small leptomeningeal artery (Grocott stain).

E. Cerebral cortex showing freely dispersed aspergillus hyphae and necrotic blood vessel (PAS) and (F)

hemorrhages and microabscesses (HE). Colonies of aspergillus hyphae in (G) the lung (Grocott stain) and (H) heart (HE).

Question 16

A and B. Multiple microabscesses in the cortex and white matter (HE).

WHAT CONDITION

Answer 16

Cerebral candidiasis

Question 17

A. Massive subarachnoid exudate with lymphocytes and plasma cells.

B. Mural thickening and luminal reduction of a parenchymal artery (HE).

WHAT CONDITION?

Answer 17

Meningovascular syphilis

Question 18

WHAT CONDITION?

A. Macrosection of lumbar spinal cord section showing demyelination of the posterior nerve roots and posterior columns.

B. Higherpower view of the demyelinated posterior nerve roots and the normal anterior nerve roots (iron hematoxylinpicrofuchsin

stain).

Answer 18

TABES

Question 19

Horizontal section of the brain shows the biopsy scar in the left caudate and a recent large granuloma in the right thalamus (D) extending into the brainstem. E. The granuloma shows coagulative necrosis, diffuse lymphocytic infi ltrations, and (F) loose nodules of microglial cells and lymphocytes HE).

WHAT CONDITION?

Answer 19

TOXOPLASMOSIS

Question 20

A. A collapsed, dead _________cyst in the dorsomedial aspect of the thalamus displays a structureless wavy collagenous wall (van Gieson).

B. Wall of the third ventricle shows perivascular lymphocytic cuffi ng (HE).

C. Granulation tissue infi ltrates the fl oor of the third ventricle (von Gieson

Answer 20

NEUROCYSTECERCOSIS

Question 21

WHAT OVA

Answer 21

SCHISTOSOMA

Question 22

A. Severe diffuse cerebral atrophy. B. Cerebral cortex showing microvacuolation and neuronal losses

and (C) prominent astrocytic proliferation (HE).

Answer 22

CJD

Question 23

A 56-year-old woman presented

with progressive visual loss, myoclonic jerks, and dementia.

She died 5 months after onset of symptoms. Microvacuolation

in the occipital cortex (HE).

Answer 23

Heidenhain variant of CJD

Question 24

A 65-year-old woman presented with headaches, speech diffi culty, gait impairment, and forgetfulness.

Her symptoms steadily progressed. Her gait became severely ataxic, she displayed dysmetria in all extremities, and

myoclonic jerks. Six months after the initial symptoms, she died. The cerebellum shows (A) severe diffuse cortical and white

matter atrophy; (B) diffuse loss of Purkinje cells, rarefaction of granular cells layer, and microvacuolation in the molecular layer

(HE); and (C) microvacuolation, neuronal loss and astrocytosis in basal ganglia (HE).

Answer 24

Ataxic-cerebellar variant of CJD.