path neuro formatted Flashcards
- 73.APRIL02 A 34 year old, mildly retarded woman is having a CT scan for presumed meningioma. She has some small nodules on her face, coloured nodules on her iris, and brown macules 2 – 3 cm in size on her hands and neck. Her parents, who accompany her, are both normal. The most likely diagnosis is
- Type I Neurofibromatosis
- Type II Neurofibromatosis
- Turcot’s syndrome
- Tuberous Sclerosis
- Trisomy 21
- 73.APRIL02 A 34 year old, mildly retarded woman is having a CT scan for presumed meningioma. She has some small nodules on her face, coloured nodules on her iris, and brown macules 2 – 3 cm in size on her hands and neck. Her parents, who accompany her, are both normal. The most likely diagnosis is Answer:
- Type I Neurofibromatosis
- Type I Neurofibromatosis
- Type II Neurofibromatosis
- Turcot’s syndrome
- Tuberous Sclerosis
- Trisomy 21
o 50% spontaneous / 50% AD
o Cutaneous Hyperpigmented Macules (Café au Lait) o Pigmented Nodules Of The Iris (Lisch Nodules)
- 84.APRIL02 Necrosis is a characteristic feature of
- Pilocytic astrocytoma
- Glioblastoma multiforme
- Acoustic schwannoma
- Craniopharyngioma
- Ependymoma
Answer:2. Glioblastoma multiforme
Usually large, heterogenous masses with central necrosis, thick, irregular “shaggy” walls, and increased vascularity with haemorrhage
• Marked mass effect & oedema
• Often find varying degrees of anaplasia within the same tumour
∴biopsy can be misleading
- 84.APRIL02 + APRIL2004 Necrosis is a characteristic feature of
- Pilocytic astrocytoma
- Glioblastoma multiforme
- Acoustic schwannoma
- Craniopharyngioma
- Ependymoma
- 85.APRIL02 A 12-year-old boy presents with a seizure and a solid mass involving the cortex of a temporal lobe is demonstrated on MRI. The most likely diagnosis is:
- DNET
- Pilocytic astrocytoma
- Anaplastic astrocytoma
- Mesial temporal sclerosis
- Pleomorphic xantho-astrocytoma
*LW: Difficult question, possibly poor recall given no perfect answer:
Preferred options of DNET vs PXA
1) DNET: multicystic bubbly cortical mass, commonly temporal lobe
2) Pilocytic astrocytoma: enhancing nodule with associated cyst, rarely cortical.
3) Anaplastic Astrocytoma may cause solid appearing cortical mass, however anaplastic occur in adulthood mean age - 40-50yrs.
4) Mesial sclerosis: neronal loss and gliosis
5) Pleomorphic xanthoastrocytoma: cortical enhancing mass with adjacent cyst, temporal lobe most common, older children.
Previous notes:
i thin it is 3 or 5: in the absence of stated associated cystic component astrocytoma possible, while age argues against. However question states age and temporal lobe, thus PXA felt most likely.
- 86.APRIL02 Which of the following statements concerning hypertensive haemorrhage IS LEAST correct?
- They are related to the lenticulo-striate arteries
- They are most common in the putamen
- They occur secondary to focal cerebral infarction
- Less than 1% occur in the posterior fossa
- They are not due to cerebral emboli
- 86.APRIL02 Which of the following statements concerning hypertensive haemorrhage IS LEAST correct?
Answer: - Less than 1% occur in the posterior fossa
- They are related to the lenticulo-striate arteries (lateral lenticulostriate arteries)
- They are most common in the putamen (Putamen / external capsule 60 – 65 %)
- They occur secondary to focal cerebral infarction (lacunar infarcts)
- Less than 1% occur in the posterior fossa
- They are not due to cerebral emboli (NOT due to emboli)
• Major sites o Predilection for areas supplied by penetrating branches of MCA & basilar artery: • 2/3rd's in basal ganglia • Putamen / external capsule 60 – 65 % • Thalamus 15 – 25 % • Pons 5 – 10% • Cerebellum 2 – 5 % • These behave like space occuping lesions leading to herniation and obstructive hydrocephalus • Subcortical lobar white matter 1 – 2 %
- 87.APRIL02 A 38 year old man with disseminated tuberculosis is having an MRl/MRA of their brain. Which of the followed would be the LEAST expected finding
- Exudate in the basal cisterns
- Hydrocephalus
- 4cm intraparenchymal cerebral mass
- Marked arterial irregularity
- Degeneration of the central portion /body of the corpus callosum
Answer:
5. Degeneration of the central portion /body of the corpus callosum This is a feature of Marchiafavia Bignami disease (Big Robbins p1329
- 87.APRIL02 A 38 year old man with disseminated tuberculosis is having an MRl/MRA of their brain. Which of the following would be the LEAST expected finding )
- Exudate in the basal cisterns (thick gelatinous exudate is found in the basal cisterns)
- Hydrocephalus (Both CT and MR can also document communicating hydrocephalus, a common sequela of tuberculous meningitis)
- 4cm intraparenchymal cerebral mass (tuberculoma)
- Marked arterial irregularity (TB meningitis - Progressive obliterative arteritis)
- Degeneration of the central portion /body of the corpus callosum This is a feature of Marchiafavia Bignami disease (Big Robbins p1329)
• CNS TB may take a variety of forms, including tuberculous meningitis, abscess, focal cerebritis, and tuberculoma.
• The most common radiographic findings associated with CNS TB include enhancement of the basal cisterns, granulomata, calcifications, hydrocephalus, meningeal enhancement, and infarction, most often of the basal ganglia.
• Coexistent pulmonary TB is often present, seen in 25% to 83% of cases of CNS TB
• Thick gelatinous exudate is found in the basal cisterns
• Arteries that course through this exudate can become directly involved by the inflammatory infiltrate, indirectly by reactive endarteritis obliterans, or by both processes, with consequent spasm and intimal changes resulting in thrombosis and infarction.
• Arteritis is present in approximately 28% to 41% of cases with basilar meningitis
• The most common parenchymal form of CNS TB is tuberculous granuloma (tuberculoma).
o Granulomata may be secondary to hematogenous spread of systemic disease or may evolve from extension of CSF infection into the adjacent parenchyma via cortical veins or small penetrating arteries
o Pathologically, the granuloma is composed of a central zone of solid caseation necrosis, surrounded by a capsule of collagenous tissue, epithelioid cells, multinucleated giant cells, and mononuclear inflammatory cells
• Tuberculomas may be found in the cerebrum, cerebellum, subarachnoid space, or subdural or epidural space.
• Parenchymal disease most often involves the corticomedullary junction and periventricular regions, as expected for hematogenous dissemination.
• Most tuberculomas are supratentorial
- 89.APRIL02 Which of the following statements IS LEAST correct concerning hypertensive changes in the brain?
- Severe hypertension may cause tentorial herniation due to diffuse cerebral edema
- The putamen is the most common site of hypertension related hemorrhage
- Hypertension is the principal cause of over 50% of primary cerebral hemorrhage
- The pons is a rare site of hypertensive hemorrhage (<1%)
- Histologically there is often a rim anoxic neural and glial change around an area old hemorrhage
answer: 4. The pons is a rare site of hypertensive hemorrhage (<1%) (5-10%)
6. 89.APRIL02 Which of the following statements IS LEAST correct concerning hypertensive changes in the brain?
- Severe hypertension may cause tentorial herniation due to diffuse cerebral edema
- The putamen is the most common site of hypertension related hemorrhage (60-65%)
- Hypertension is the principal cause of over 50% of primary cerebral hemorrhage
- The pons is a rare site of hypertensive hemorrhage (<1%) (5-10%)
- Histologically there is often a rim anoxic neural and glial change around an area old hemorrhage
• Patients coming to postmortem examination may show an edematous brain weighing more than normal, with or without transtentorial or tonsillar herniation
- 90.APRIL02 Concerning CNS demyelination, which of the following statements is correct:
- Acute disseminated encephalomyelitis (ADEM) typically follows a bacterial infection
- Central pontine myelinosis is due to rapid correction of hyperkalaemia
- Multiple sclerosis lesions do not involve the corpus callosum
- Depletion of oligodendrocytes is a feature of MS lesions
- Multiple sclerosis increases in frequency with HIV
Answer:4. Depletion of oligodendrocytes is a feature of MS lesions (Loss of myelin & oligodendrocytes)
- 90.APRIL02 Concerning CNS demyelination, which of the following statements is correct:
- Acute disseminated encephalomyelitis (ADEM) typically follows a bacterial infection (viral)
- Central pontine myelinosis is due to rapid correction of hyperkalaemia (Caused by rapid correction of hyponatraemia or extreme serum hyperosmolarity)
- Multiple sclerosis lesions do not involve the corpus callosum (Corpus callosum in 50 – 90%)
- Depletion of oligodendrocytes is a feature of MS lesions (Loss of myelin & oligodendrocytes)
- Multiple sclerosis increases in frequency with HIV
- 91.APRIL02 Concerning central neurocytomas, which of the following statements IS INCORRECT:
- They arise in the region of the septum pellucidum
- Histologically (H&E stain) they resemble oligodendrogliomas
- They do not result in hydrocephalus
- They present in young adults
- Calcification is common
Answer:3. They do not result in hydrocephalus (100% have ventriculomegaly)
- 91.APRIL02 Concerning central neurocytomas, which of the following statements IS INCORRECT:
- They arise in the region of the septum pellucidum (Lateral ventricle adjacent to foramen of Monro and septum pellucidum, occasionally involves 3rd ventricle, rarely alone)
- Histologically (H&E stain) they resemble oligodendrogliomas (Mistaken for intraventricular oligodendroglioma on imaging & histologically – indistinguishable)
- They do not result in hydrocephalus (100% have ventriculomegaly)
- They present in young adults (Young adults (20 – 40 yrs))
- Calcification is common (> 60% have calcification)
- 23.02.25 Chronic alcoholic presents with nystagmus, ophthalmoplegia, ataxia, but with preserved speech, no facial droop. What is likely diagnosis?
- Wernicke’s encephalopathy
- Marchiafava Bignami syndrome
- Korsakoff’s syndrome
- Cerebellar infarct
- Osmotic pontine myelinosis
Answer:
1. Wernicke’s encephalopathy
- 23.02.25 Chronic alcoholic presents with nystagmus, ophthalmoplegia, ataxia, but with preserved speech, no facial droop. What is likely diagnosis? Rob p839
- Wernicke’s encephalopathy
- Marchiafava Bignami syndrome (Onset is usually insidious, with the most common symptom be¬ing nonspecific dementia)
- Korsakoff’s syndrome (Severe amnesia, causing confabulation, while patient remains alert & responsive)
- Cerebellar infarct (will have dysarthria)
- Osmotic pontine myelinosis (“locked-in” state)
- Wernicke encephalopathy is marked by ophthalmoplegia; nystagmus; ataxia of gait and stance; and derangement of mental function, characterized by global confusion, apathy, listlessness, and disorientation
- MRI findings are characteristic and include T2 hyperintensity within the medial thalamic nuclei (46%), the periaqueductal gray matter (40%), and the mamillary bodies. The acute lesions may enhance. Mamillary body abnormal signal intensity &/or enhancement may be the only finding of WE.
- 74.APRIL02 A 42-year-old alcoholic presents with confusion, nystagmus, opthalmoplegia ataxic gait but normal speech and facial movements. An MRI is ordered, These findings would be best be explained by;
- Cerebellar infarct
- Marchiafava-Bignami syndrome
- Central pontine myelinolysis
- Wernicke syndrome
- Korsakoff syndrome
- Wernicke syndrome
- 75.APRIL02 A 46-year-old man with non-Hodgkin’s lymphoma suffers increasing headache and drowsiness over 2 weeks. CSF examination shows small round cells with a thick gelatinous capsule, well appreciated on Indian ink suspension. This is most likely to represent:
- Cerebral involvement with candida
- Cerebral involvement with tuberculosis
- Cerebral involvement with cryptococcus
- Cerebral involvement with non-Hodgkin’s lymphoma
- Transformation of the lymphoma and secondary cerebral involvement with acute lymphoblastic leukaemia
- Cerebral involvement with cryptococcus
• May show encapsulated yeasts of Cryptococci on India Ink or Cryptococcal antigen, or in tissue sections by PAS, mucicarmine and silver stains (esp. frequent in debilitated or immunocompromised patients)
- 23.03.89 Pick’s disease, UNCOMMON FINDING ? Dan p314
- Assymetrical atrophy
- Predominant frontal lobes
- Cortical atrophy
- Involvement of posterior 2/3 superior temporal gyrus
- Putamen changes
answer:
4. Involvement of posterior 2/3 superior temporal gyrus
- 23.03.89 Pick’s disease, UNCOMMON FINDING ? Dan p314
- Asymmetrical atrophy
- Predominant frontal lobes
- Cortical atrophy
- Involvement of posterior 2/3 superior temporal gyrus
- Putamen changes
LJS opinion* I think putamen changes unlikely
Temporal lobes involved, anterior more than posterior
Can’t find involvement of deep structures anywhere. So I think 5 is uncommon finding
***LW:
Per UTD: gross pathology of all frontotemporal lobar degeneration (FTLD) subtypes demonstrates damage in the frontal and/or temporal lobes. Cortical and/or basal ganglia atrophy may manifest symmetrically or asymmetrically; substantia nigra depigmentation occurs in a subset of cases. While the FTD clinical syndrome usually targets the frontoinsula and the anterior cingulate, specific atrophy patterns may be associated with underlying neuropathology.
–> In the subset of FTLD-tau pathology known as Pick disease, Pick bodies develop in the granule cells of the dentate gyrus, the pyramidal neurons in the CA1 region of the hippocampus, and the pyramidal neurons in the frontal and temporal lobes. Tau deposition in Pick disease progresses sequentially, beginning in the frontotemporal limbic/paralimbic and neocortical regions, then involving subcortical structures (eg, basal ganglia, locus ceruleus, raphe nuclei), primary motor cortex and precerebellar nuclei, and finally visual cortex
- 23.03.86 Mycotic aneurysms ? Rob p813
- Rarely bleed
- Peripheral arterial
- Circle of Willis
- Peripheral arterial in the brain anyway.
- 88.APRIL02 What are the most commonly involved organisms in cerebral abscesses?
- Gram negative anaerobes
- Streptococci and staphylococci
- Haemophilus and menigococcus
- Heemophilus and pneumococcus
- Staphylococci and mycobacteria
- Streptococci and staphylococci
- 23.02.24 What is the most common cause of brain abscess in adult?
- Streptococcus & Staph
- Staph & TB
- Staph & Toxo
- TB & Nocardia
- PML
- Streptococcus & Staph
- 23.02.74 CNS features NOT typical of TB are ?
- basal meningeal enhancement
- 4cm focal mass
- irregularity of vessels
all are feature of TB haha
- 23.03.07 In HSV I encephalitis which is TRUE
- Age 50-70 years
- Typically involves superior frontal lobes
- Commonest presentation is headache
- A subacute presentation with ataxia and seizures is recognized
- Oncocytic intracytoplasmic inclusions
Answer:3. Commonest presentation is headache (alterations in mood,memory and behavior is most common presentation)
- 23.03.07 In HSV I encephalitis which is TRUE Rob p828-829
- Age 50-70 years (most common in children and young adults)
- Typically involves superior frontal lobes (predilection for the limbic system (temporal lobes, cingulate gyri, subfrontal region))
- Commonest presentation is headache (alterations in mood,memory and behavior is most common presentation)
- A subacute presentation with ataxia and seizures is recognized
- Oncocytic intracytoplasmic inclusions (Cowdry Intranuclear inclusion bodies)
- 23.02.22 Creutz-Jakob disease –what would be UNUSUAL finding ?
- Cortical atrophy is rarely found
- Survival of 3-3½ years
- 23.02.22 Creutz-Jakob disease –what would be UNUSUAL finding ? Rob p830
Answer:2. Survival of 3-3½ years (uniformly fatal usually within 7 months) - Cortical atrophy is rarely found (brain appears grossly normal (no significant atrophy), as progression of dementia so rapid)
- Survival of 3-3½ years (uniformly fatal usually within 7 months)
- 23.02.36 Microscopic features of GBM DO NOT include ?
1. Necrosis and areas of different histology
incomplete questionRobins: 1308 The histologic appearance of glioblastoma is similar to anaplastic astrocytoma with the additional features of necrosis and vascular/endothelial cell proliferation.Necrosis in glioblastoma often occurs in a serpentine pattern in areas of hypercellularity.Tumor cells collect along the edges of the necrotic regions, producing a histologic pattern referred to as pseudo-palisadingThe vascular cell prolif- eration produces tufts of cells that pile up and bulge into thelumen; the minimal criterion for this feature is a double layer of endothelial cells. With marked vascular cell proliferation the tuft forms a ball-like structure, the glomeruloid body. VEGF, pro- duced by malignant astrocytes in response to hypoxia, contrib- utes to this distinctive vascular change. Since histologic features can be extremely variable from one region to another, small biopsy specimens may not be representative of the entire tumor.
- 23.02.42 Commonest sites for ependymoma are ?
- Fourth ventricle in children and spine in adults
- Lateral and third ventricle in infants…..
- Periventricular areas (permutations of adult/infant/children)
- Fourth ventricle in children and spine in adults
- 23.02.34 Ganglioglioma ? 1. Superficial location
(Most commonly superficial and supratentorial (temporal > frontal > parietal))
- 23.02.25 Alcoholic, treatment for Wernickes has rapid change in heart size over 1 wk. Most likely:
- Dehydration
- Resolution of pericardial effusion
- Projectional change on CXR
- Beri-beri heart disease
- Beri-beri heart disease this is caused by vit B1 (Thiamine) deficiency can cause acute heart failure with decreased LV systolic function and enlargement +/-
- 23.03.10 In a alcoholic with hyponatraemic and parietal paresis, which is MOST LIKELY:
- Central pontine myelinolysis
- Pontine myelinolysis, midbrain and supratentorial diseases
- Pontine lesions secondary to thiamine defiency
- Subacute combined degeneration of cord secondary to thiamine defiency
- Cord degeneration secondary secondary to folate defiency
*LW:
Correct terminology is osmotic demyelination syndrome / osmotic myelinolysis; which is a global term of both central pontine and extra pontine myelinolysis.
Central pontine myelinolysis clinical features:
dysarthria and dysphagia (secondary to corticobulbar fibre involvement), a flaccid quadriparesis (from corticospinal tract involvement) which later becomes spastic, all from involvement of the basis pontis.
if the lesion extends into the tegmentum of the pons - pupillary, oculomotor abnormalities may occur. There may be an apparent change in conscious level reflecting the “locked-in syndrome” that a large lesion in this site is particularly liable to produce.
Extra pontine myelinolysis clinical features:
Movement disorders
Mutism, parkinsonism, dystonia, and catatonia
- Central pontine myelinolysis
- 23.03.87 Patient with drug resistant Parkinsons and autonomic neuropathy ?
- Shy Drager Syndrome
- Drug resistant Parkinsons
- Striatnigeral degeneration
- Olviopontocerebellar atrphy
- Progressive supranuclear palsy
- Huntingtons
- Shy Drager Syndrome
• Parkinsonism with autonomic system failure, often manifesting as orthostatic hypotension
o orthostatic hypotension
o urinary incontinence
o inability to sweat
• Loss of neurones from intermediolateral column of spinal cord
o explains sympathetic dysfunction
• May be similar pathologically to Parkinson disease (Lewy bodies) or striatonigral degeneration (widespread neuronal loss)
• Shy Drager Syndrome
• Multiple system atrophy with autonomic failure; is a progressive disorder of the central and autonomic nervous systems. The disorder is characterized by postural hypotension
• There are 3 types of Shy-Drager syndrome:
o Parkinsonian-type which may include symptoms of Parkinson’s disease such as slow movement, stiff muscles, and mild tremors
o cerebellar-type which may include problems such as loss of balance and the tendency to fall; and
o combination-type