Neuropatology

Question 1

Peripheral nerves can be a common location of complications from

Answer 1

DM

Question 2

The pathologic lesion is thought to arise from

Answer 2

Microvascular injury

Question 3

Common nerve conditions include 3rd nerve palsy, mononeuropathy multiplex, diabetic amyotrophy, and autonomic neuropathy

Answer 3

Diabetic Neuropathy

Question 4

Conseqences include herniation through openings between brain regions including under the falx cerebri, across the tentorium cerebelli, or through the foramen magnum

Answer 4

Cerebral Edema

Question 5

Linear pontine hemorrhages seen almost exclusively in downward herniation through tentorium cerebelli

Answer 5

Duret Hemorrhage

Question 6

When there is no division of the cerebral hemispheres

Answer 6

Alobar holoprosencephaly

Question 7

The problem appears to be in signalling of developmental proteins in the Sonic Hedgehog pathway in the embryonic face/brain region, so that midline structures are malformed, including the normal midline split of the developing cerebrum into two hemispheres

Answer 7

Alobar holoprosencephaly

Question 8

A cephalic disorder in which the single prosencephalic vesicle fails to split into two hemispheres

Answer 8

Holoprosencephaly

Question 9

Manifests with little apparent damage in neuroimaging studies, but lesions can be seen with microscopy techniques post-mortem

Answer 9

Mild diffuse axonal injury

Question 10

Virtually always the result of a trauma that causes a tear in the middle meningeal artery

Answer 10

Epidural Hematoma

Question 11

Dural vessels—especially the middle meningeal artery— are vulnerable to

Answer 11

Epidural hematoma

Question 12

Patients may be lucid for several hours before symptoms develop

Answer 12

Epidural hematoma

Question 13

Manifest within 48 hours with localizing or (more often) non-localizing symptoms

Answer 13

Subdural hematoma

Question 14

Pyramidal cells of the hippocampus and Purkinje cells of the cerebellum are the most susceptibel neurons for infarcts from

Answer 14

Global Ischemia/Hypoxia

Question 15

Wedge-shaped infarcts in regions perfused by most distal portions of arteries

-Usually seen after hypotensive episodes

Answer 15

Watershed (Borderzone) Infarcts

Question 16

From cerebral arterial occlusion. Less damaging in areas of collateral circulation

Answer 16

Infarcts from cerebral ischemia

Question 17

Can be ischemic (bland, white, common; thrombolytic therapy possible), hemorrhagic (less common; thrombolytic therapy counterindicated), or “transformed” into hemorrhagic (unclear incidence)

Answer 17

Infarcts

Question 18

Hemorrhages involving the basal ganglia area (the putamen in particular) tend to be non-traumatic and caused by

Answer 18

Hypertension

Question 19

Causes hyaline arteriolar sclerosis of the deep penetrating arteries/arterioles supplying the basal ganglia, hemispheric white matter, and brain stem

Answer 19

Hypertension

Question 20

Small (a few millimeters) cavity infarct in the deep gray matter (basal ganglia and thalamus), internal capsule, deep white matter, and pons

Answer 20

Lacunar Infarct

Question 21

Due to occlusion of a small deep penetrating artery as a consequence of aging, hypertension, smoking, and diabetes mellitus

Answer 21

Lacunar Infarct

Question 22

A ruptured berry aneurysm with subarachnoid hemorrhage leads to sudden onset of an excruciating

Answer 22

Headache

Question 23

90% occur in the anterior circulation near major branch points

Answer 23

Saccular Aneurysms

Question 24

1/3 of cases of ruptured saccular aneurysms come from an acute increase in

Answer 24

Intracranial Pressure

Question 25

What 4 things does the CSF show for acute bacterial meningitis?

Answer 25

1. ) Increased opening pressure 2. ) Abundant Neutrophils 3. ) Elevated Protein 4. ) Reduced Glucose

Question 26

Granulation tissue that becomes dense fibrosis over time

Answer 26

Wall of brain abscess

Question 27

Almost always from bacterial infection -Hematogenous spread, often from heart, lungs, distal bone, tooth extraction

Answer 27

Brain Abscess

Question 28

What are the three characteristics of CSF in a brain abscess case?

Answer 28

1. ) Increased white cells 2. ) Increased Protein 3. ) Glucose is normal

Question 29

Most common in children and young adults, with alterations in mood, memory, and behavior

Answer 29

HSV-encephalitis

Question 30

Thought to be due to retrograde transmission from a peripheral to a central location along a cranial nerve

Answer 30

HSV-Encephalitis

Question 31

An umbrella term for different neurological disorders associated with HIV infection and AIDS, including mild to severe dementia

Answer 31

HIV-Associated Neurocognitive Disorder (HAND)

Question 32

Activation of macrophages and microglia is a characteristic of

Answer 32

HIV

Question 33

Characteristic pathologic feature is the microglial nodule with the macrophage-derived multinucleate giant cell

Answer 33

HIV encephalitis

Question 34

The virus travels along peripheral nerves at the wound site to the central nervous system -So incubation period depends on the distance of the wound from the brain

Answer 34

Rabies (w/ Negri Body)

Question 35

Manifests with nonspecific headache, malaise and fever

Answer 35

Rabies

Question 36

Then shows extraordinary CNS excitability including HYDROPHOBIA

Answer 36

Rabies

Question 37

The vacuoles in CJD represent swollen dendrites that are generally close to neuronal cell bodies, and this is the site of much of the abnormal

Answer 37

Prion Protein

Question 38

A sporadic (85% of cases), transmissible, or hereditary disease with rapidly progressive dementia -Death in 7 Months

Answer 38

CJD

Question 39

CJD is “Spongiform” because the cerebral cortex and deep gray matter become riddled with microscopic

Answer 39

Vacuoles

Question 40

A very large indicator of MS is CSF presence of

Answer 40

IgG antibodies

Question 41

An autoimmune demyelinating disease with multiple neurologic deficits at different times due to white matter lesions spatially distinct

Answer 41

MS

Question 42

Usually relapsing and remitting episodes of neurologic impairment -Subset of patients steadily deteriorate

Answer 42

Multiple Sclerosis (MS)

Question 43

Primarily a white matter disease with multiple plaques, though axons may be numerically reduced -Probable central role for CD4+ T-cells

Answer 43

MS

Question 44

The characteristic microscopic findings of Alzheimer’s disease are neuritic plaques and

Answer 44

Neurofibrillary Tangles

Question 45

Neuritic plaques are formed from a central core of neurotoxic extracellular

Answer 45

AB protein

Question 46

One of the neurodegenerative diseases characterized by degeneration of neurons related by function rather than by location in the brain

Answer 46

Alzheimer's Disease (AD)

Question 47

Cleavage of amyloid precursor protein (APP) yields beta amyloid (Ab), which accumulates and injures neurons in

Answer 47

AD

Question 48

An additional risk factor for AD is an apoprotein called

Answer 48

ApoE4

Question 49

A syndrome with diminished facial expression, stooped posture, slowness of voluntary movement, festinating gait, rigidity, and a “pill-rolling” tremor

Answer 49

Parkinsons Disease

Question 50

Due to damage to the nigrostriatal dopaminergic system

Answer 50

Parkinson's disease

Question 51

Parkinson's has characteristic neuronal inclusions of a-synuclein called

Answer 51

Lewy Bodies

Question 52

At autopsy the brain shows pallor of the substantia nigra and the locus ceruleus

Answer 52

Parkinson's

Question 53

The pallor is due to loss of the pigmented

Answer 53

Catelcholaminergic neurons

Question 54

Symptomatic treatment with L-DOPA therapy does not

Answer 54

Halt disease progression of PD

Question 55

A neurodegenerative disease with loss of both lower motor neurons and upper motor neurons

Answer 55

ALS

Question 56

Characterized by muscle denervation and atrophy, weakness, and fasciculations

Answer 56

LMN loss in ALS

Question 57

Characterized by paresis, hyperreflexia, and spasticity and degeneration of the corticospinal tracts

Answer 57

UMN loss in ALS

Question 58

Usually begins in the 5th decade with subtle asymmetric distal extremity weakness

Answer 58

ALS

Question 59

A syndrome with abrupt onset of confusion, abnormal eye movements, and ataxia

Answer 59

Wernicke-Korsakoff

Question 60

Pathologically there are foci of hemorrhage and necrosis in the mammillary bodies and adjacent to the ventricles

Answer 60

Wernicke-Korsakoff

Question 61

High grade with dense cellularity and much nuclear pleomorphism and mitoses

Answer 61

Anaplastic Astrocytoma

Question 62

Same histologic appearance as an anaplastic astrocytoma plus necrosis and vascular proliferation

Answer 62

Glioblastoma

Question 63

Viable cells often form “pseudo-palisades” around vessels (radially-oriented rows of nuclei)

Answer 63

Glioblastoma

Question 64

A mostly benign, well-defined, dura-based mass that may compress the subjacent brain

Answer 64

Meningioma

Question 65

Most separate easily from underlying brain, but some are infiltrative -Arise from arachnoid meningothelial cells

Answer 65

Meningioma

Question 66

Mostly carcinomas—account for ¼-½ of intracranial tumors -80% from primaries in lung, breast, skin (melanoma), kidney, and GI tract

Answer 66

Brain Metastasis

Question 67

Form well-delineated masses, frequently at the grey-white junction, and often produce edema

Answer 67

Brain Metastasis

Question 68

Benign, encapsulated peripheral nerve tumor arising from Schwann cells

Answer 68

Schwannoma

Question 69

Appears as a circumscribed mass abutting an adjacent nerve, usually without involvement of axons

Answer 69

Scwannoma

Question 70

May affect the vestibular portion of the 8th cranial nerve leading to hearing loss

Answer 70

Schwannoma

Question 71

Mostly sporadic but 10% are associated with familial neurofibromatosis type 2

Answer 71

Schwannoma