Nervous system

Question 1

Answer 1

Vasogenic edema - pale areas

Question 2

Answer 2

Subacute infarct - foamy macrophages

Question 3

Answer 3

The subarachnoid hemorrhage from a ruptured aneurysm shown here at the base of the brain is more of an irritant producing vasospasm than a mass lesion. However, a large aneurysm could act like a mass and press on the brainstem or cranial nerve.

Question 4

Answer 4

PD midbrain loss of substantia nigra

Question 5

Answer 5

Meningioma

benign

attached to dura

encapsulated

en plaque growt - sheet like spread

syncytial / fibroblastic / transitional/ psammomatous (whorls of cells)

Question 6

Answer 6

Medulloblastoma - Homer Wright

Question 7

Answer 7

Lewy bodies

At the left, an H&E stain shows a rounded pink cytoplasmic Lewy body in a neuron of the cerebral cortex from a patient with diffuse Lewy body disease, which can be a cause for dementia. Lewy bodies can also be seen in substantia nigra with Parkinson disease. An immunohistochemical stain for ubiquitin, seen at the right, helps demonstrate the Lewy bodies more readily by the collection of intense brown reaction product within them.

Question 8

Answer 8

Lacunar infarct - cystic space due to liquefactive necrosis

Question 9

Answer 9

Glioblastoma - pseudo pallisading cells, cystic degeneration, anaplastic, necrosis

Question 10

Answer 10

Glioblastoma gross - hemorrhage, firm white / soft yellow

Primary: xPTEN, EGFR^, xCDKN2A

Secondary: xTP53, IDH1/2 (longer survival), PDGFR^

Question 11

Answer 11

Glioblastoma

Question 12

Answer 12

Ependymoma, vascular rosettes

Question 13

Answer 13

Cystic space, liquefactive necrosis

Question 14

Answer 14

Cerebral edema shift of midline to the left

Question 15

Answer 15

Cerebral edema wide gyri narrow sulci

Question 16

Answer 16

Bacterial meningitis - neutrophilic exudate

Question 17

Answer 17

Astrocytoma

Diffuse - poorly defined, gray, greater cellularity, GFAP+

Localized (pylocytic - cystic, in children, bipolar cells with long thin hairlike processes Rosenthal fibers

Anaplastic - dense cellularity, nuclear pleomophism, mitotic figures

Gemistocytic - astrocytes with brightly eosinophilic bodies, stout processes (swollen, reactive astrocyte)

Question 18

Answer 18

AD neurofibrillary tangle

Question 19

Answer 19

AD neuritic plaques - Congo Red

Question 20

Answer 20

Acute cerebral infarct

Question 21

Answer 21

Abscess - trichrome blue shows CT

Question 22

Answer 22

Substantia nigra left normal right PD

Question 23

Answer 23

Oligodendroglioma

fried egg, calcifications, anastomosing capillaries, no mitotic activity, well circumscribed

Question 24

Answer 24

Oligodendroglioma

Solid sheets with finely granular nuclear chromatin, surrounded by a halo of vacuolated cytoplasm

Question 25

Intracerebral hemorrhage

Answer 25

An intraparenchymal hemorrhage occurs within the brain tissue itself and is usually the result of high blood pressure (hypertension), a tumor, a cavernous malformation, or an arteriovenous malformation (AVM).

hypertension, current smoking, excessive alcohol consumption, hypo- cholesterolemia, and drugs. Old age, male sex, Asian ethnicity, chronic kidney disease, cerebral amy- loid angiopathy (CAA), and cerebral microbleeds (CMBs) increase the risk of ICH

Question 26

Epidural hematoma

Answer 26

An epidural hematoma (EDH) occurs when blood accumulates between the skull and the dura mater, the thick membrane covering the brain. They typically occur when a skull fracture tears an underlying blood vessel. EDHs are about half as common as a subdural hematomas and usually occur in young adults.

• are an older adult.
• have trouble walking without falling.
• have experienced trauma to your head.
• take blood thinning medications.
• drink alcohol, which increase your risk of falls and other accidents.
• don’t wear a protective helmet during contact activities.

Question 27

Subdural hematoma

Answer 27

Subdural hematoma is usually caused by a head injury, such as from a fall, motor vehicle collision, or an assault.

• Chronic alcoholism.
• Epilepsy.
• Coagulopathy.
• Arachnoid cysts.
• Anticoagulant therapy (including aspirin)
• Cardiovascular disease (eg, hypertension, arteriosclerosis)
• Thrombocytopenia.
• Diabetes mellitus.

Question 28

Subarachnoid hemorrhage

Answer 28

SAH is most commonly caused by a brain aneurysm. A brain aneurysm is a ballooning of an artery in the brain that can rupture and bleed into the space between the brain and the skull.

Smoking, hypertension, and excessive alcohol remain the most important risk factors for SAH.