Past Paper Questions

Question 1

Whorls on histology, with or without psammoma bodies

Answer 1

Meningioma

Question 2

Meningiomas originate from…

Answer 2

Arachnoid “cap” cells of the arachnoid villi in the meninges, meningothelial cell of the subarachnoid or stromal arachnoid cells of the choroid plexus.

Question 3

Meningiomas are most common at the…

Answer 3

Superior parasagittal surface of frontal and parietal lobes, along the sphenoid ridge, in the olfactory grooves, the sylvian region, superior cerebellum along the falx cerebri, cerebellopontine angle, and the spinal cord

Question 4

On MRI, meningiomas are…

Answer 4

Grey, well circumscribed, dome shaped with base at dura, bosselated or polypoid appearance, en plaque (along dura in a sheet).

Question 5

Brain mets come from…

Answer 5

Lung cancer 48%, breast 15%, genitourinary tract 11%, osteosarcoma 10% and melanoma 9%. Head and neck cancers cause only 6%

Question 6

Treatment for brain mets?

Answer 6

Primarily palliative, aiming to reduce symptoms. Some patients can have aggressive therapy such as craniotomy with maximal excision, chemo, and radiosurgical intervention (gamma knife radiosurgery)

Question 7

Location Septum Pellucidum?

Answer 7

Not to be confused with the medial septum, the SP is a thin, triangular, vertical membrane separating the anterior horns of the left and right lateral ventricles of the brain. It runs as a sheet from the corpus callosum down to the fornix.

Question 8

Why are midline structures more susceptible to trauma?

Answer 8

Held rigidly in place by dura and at the centre resulting in shearing or tearing force generated by rotational trauma as the two hemispheres shift move separately to one another.

Question 9

Describe what effect raised intracranial pressure has had on the brain.

Answer 9

Midline deviation, ridge on the uncus of the right temporal lobe indicates it’s herniated through the tentorial notch. Also the top of the right cerebellum has been squashed by the herniated lobe.

Question 10

In agenesis of the corpus callosum, where do the fibres lie and what are they called?

Answer 10

Probst bundles, longitudinally. Bat wing deformity of ventricles.

Question 11

What is encephalocoele?

Answer 11

Neural tube defect characterised by sac-like protrusions of the brain and the membranes that cover it through openings in the skull. The result is a groove down the midline of the upper part of the skull, or the area between the forehead and nose, or the back of the skull. When located in the back of the skull, encephaloceles are often associated with neurological problems.

Question 12

What causes periventricular heterotopia?

Answer 12

The problem is complete failure of migration from the germinal layer of ventricular zone that lines the neural tube to the desired region of the cortex by some differentiated neurons. Consequently many neurons remain in the ventricular zone as clumps or nodules whilst the remainder form the rest of the cortex. Type of cortical dysplasia.

Question 13

Fronto-temporal dementia -

Answer 13

Pick’s disease (most common?)

Question 14

What happens after a blockage in the cerebral aqueduct?

Answer 14

Hydrocephalus

Question 15

Why is white matter more susceptible to damage after status epilepticus?

Answer 15

More susceptible to hypoxic insult, rotational trauma.

Question 16

Huntington’s disease leads to what gross anatomical changes?

Answer 16

Apparent enlargement of the ventricles is due to atrophy of the head of the caudate, putamen, globus pallidus from neuronal loss. Atrophy is frequently also seen in the frontal lobe, less often in the parietal lobe and occasionally of the whole cortex.

Question 17

What can be seen on histology of Alzheimer’s disease?

Answer 17

Senile plaques of amyloid beta protein, with cerebral amyloid angiopathy. Later, there are increased numbers of microglia in related areas of the cerebral cortex and, subsequently, degeneration of the involved fibre tract

Question 18

What can be seen on histology of diffuse axonal injury?

Answer 18

Axonal swellings, retraction bulbs?

Question 19

Where is DAI most likely to be seen?

Answer 19

Parasagittal parts of the brain, the corpus callosum, fornix, internal capsule, and the brain stem.

Question 20

Function of astrocytes?

Answer 20

Sample environment, control nutrients and metabolites through blood-brain barrier, neurotransmitter metabolism (GABA to glutamine), ion redistribution (K+ reservoir), glycogen storage, water storage, transport molecules over 1kDa, control cerebrovasculature via arachidonic acid and prostaglandins.

Question 21

In which pathology is the substantia nigra affected?

Answer 21

Parkinson’s disease

Question 22

What can be seen on histology of Prion disease?

Answer 22

Multiple vacuoles within the neuropil and sometimes the perikaryon of neurons. spongiform changes of cerebral cortex, and often, deep-gray matter structures (caudate, putamen).

Question 23

Describe brain mets

Answer 23

Intraparenchymal metastases form sharply demarcated masses, often at the junction of gray and white matter, usually surrounded by a zone of edema. Nodules of tumour, often with central areas of necrosis, are surrounded by reactive gliosis. Meningeal carcinomatosis, with tumour nodules studding the surface of the brain, spinal cord and intradural nerve roots, is associated particularly with carcinoma of the lung and the breast.

Question 24

What happens in transtentorial or uncinate herniation?

Answer 24

The medial aspect of the temporal lobe is compressed against the free margin of the tentorium. With increasing displacement of the temporal lobe, the third cranial nerve is compromised, resulting in pupillary dilatation and impairment of ocular movements on the side of the lesion.

Question 25

Where does hypertensive Intraparenchymal haemorrhage occur?

Answer 25

The putamen (50 to 60%) of cases, thalamus, pons, cerebellar hemispheres (rarely), and other regions of the brain.

Question 26

In tau negative FTLD, what are found instead and where?

Answer 26

Ubiquitin-containing inclusions are found in superficial cortical layers in temporal and frontal lobes and in the dentate gyrus. Some of these cases show linkaged to Chr 17.

Question 27

What is the gross anatomy of periventricular heterotopia?

Answer 27

Nodules of of gray matter under the ependyma of the lateral ventricles.

Question 28

Describe the gross appearance of glioblastoma multiforme?

Answer 28

In GBM variation in the gross appearance of the tumour from region to region is characteristic. Some areas are firm and white, others are soft and yellow due to necrosis, and yet others show regions of cystic degeneration and haemorrhage.

Question 29

Describe the flow of CSF

Answer 29

The choroid plexus produces CSF, which normally circulates through the lateral ventricles, through the foramen of Monro, into the third ventricle, through the cerebral aqueduct, into the fourth ventricle and then some goes down the spinal cord and some enters the cisterna magna at the base of the brain stem through three apertures - medial (foramen of Magendie) and two lateral (foramina of Luschka) to bathe the brain.

Question 30

Where is the locus coeruleus?

Answer 30

Pons