CNS Quiz For Pathology

The correct answer is aneurysm. An aneurysm is a bulge or ballooning in a blood vessel, usually caused by a weak spot in the vessel wall. When an aneurysm ruptures, it can cause a sudden and severe headache, often described as the worst headache of one's life. The headache may worsen with activities that increase intracranial pressure, such as straining while passing stool or having sex. This is because increased pressure can further stress the weakened vessel wall, leading to rupture and bleeding. Hypertension (high blood pressure) can also contribute to the development and rupture of an aneurysm, but it is not the most common etiology in this scenario.

The middle meningeal artery is involved in this scenario. The symptoms described, such as headache, vomiting, seizures, hypertension, and bradycardia, are consistent with a condition called an epidural hematoma. This occurs when there is bleeding between the skull and the outermost layer of the brain, known as the dura mater. The middle meningeal artery runs in this space and can be damaged by a blow to the side of the head, leading to bleeding and the subsequent symptoms.

The most common cause of intracerebral hemorrhage is associated with cerebral amyloid angiopathy and high cholesterol. Cerebral amyloid angiopathy is a condition where amyloid protein deposits in the blood vessels of the brain, weakening them and making them prone to rupture. High cholesterol can lead to the formation of fatty plaques in the blood vessels, increasing the risk of rupture and bleeding. Both these factors contribute to the development of intracerebral hemorrhage. Tumors and liver failure can also cause bleeding in the brain, but they are not the most common causes.

If the patient were infected with E.Coli, the glucose levels in the CSF would decrease. This is because E.Coli is a bacteria that consumes glucose as a source of energy. As a result, the bacteria would utilize the glucose in the CSF, leading to a decrease in its levels. This decrease in glucose levels, along with the elevated protein levels, is indicative of a bacterial infection rather than a viral one.

Based on the given information, the child's tumor is located in the vermis of the medulla and is gray and friable. Microscopically, there are small blue cells present. Additionally, the child is experiencing symptoms associated with cerebellar dysfunction. These characteristics suggest that the tumor is likely malignant and aggressive, leading to a poor prognosis if left untreated.

The underlying possible mechanism of the baby's disease, Dandy-Walker syndrome, could be a tumor or hemorrhage/inflammations. These conditions can cause the symptoms mentioned, such as pupillar dilation, visual disturbances, difficulty breathing, and an enlarged head. Arachnoid granulations and Alzheimer's are not typically associated with Dandy-Walker syndrome, so they are not the underlying mechanisms in this case.

The correct answer is Neurofibromatosis type 2 and psammoma bodies. This is because the patient is presenting with focal neurological deficits, increased intracranial pressure, headaches, and hyperostosis of overlying bone, which are common features of Neurofibromatosis type 2. Psammoma bodies are also commonly seen in tumors arising from meningothelial cells of the arachnoid matter.

The correct answer is JC polyomavirus; enlarged oligodendrocytes. Chronic Myelogenous Leukemia (CML) is a type of cancer that affects the white blood cells. The presence of many lesions in the white matter of the cerebellum, along with the destructive nature of these lesions, suggests an opportunistic infection in an immunosuppressed individual. JC polyomavirus is known to cause progressive multifocal leukoencephalopathy (PML), a condition characterized by demyelination in the central nervous system. Enlarged oligodendrocytes are a key histological feature observed in PML caused by JC polyomavirus.

The correct answer is oligodendrocyte. Oligodendrocytes are a type of glial cell in the central nervous system that produce myelin, a substance that insulates and protects nerve fibers. The description of the tumor as slow growing with microcysts, myxoid material, and very few cells suggests a tumor of low cellularity, which is characteristic of oligodendrogliomas. Oligodendrogliomas are tumors that arise from oligodendrocytes and are typically slow growing with a similar appearance to the cells of origin. Therefore, the function of oligodendrocytes is similar to the cell of origin in this case.

The correct answer is "butterfly appearance." A butterfly appearance refers to the shape of the tumor, which typically spans across the midline of the brain, resembling the wings of a butterfly. This is a characteristic feature of glioblastoma multiforme, a highly aggressive type of brain tumor that arises from the glial cells in the white matter. The rapid expansion, gray color, and poor definition mentioned in the question are consistent with the aggressive nature of glioblastoma multiforme. The increased number of glial cells arranged in a palisading manner is another characteristic histological feature of this tumor.

Multiple sclerosis is a chronic autoimmune disease that affects the central nervous system, specifically the brain and spinal cord. It is characterized by the destruction of the protective covering of nerve fibers, called myelin, leading to communication problems between the brain and the rest of the body. In the case of the patient with overcorrected hyponatremia, there may be damage to the nerves or disruption in the communication between the brain and other parts of the body, similar to the pathology seen in multiple sclerosis.

The correct answer is hematoma. A hematoma is a collection of blood outside the blood vessels, usually caused by trauma or injury. In this case, the patient's symptoms of headache, contralateral weakness, seizures, and cognitive impairment are consistent with the effects of a hematoma on the brain. These symptoms are not typically associated with conditions such as tumor, respiratory illness, sexually transmitted disease, or liver cirrhosis.

Patients with a loss of upper motor neurons often develop weakness and wasting of muscles, as well as other symptoms such as spasticity and fasciculations. These patients are at a higher risk of developing pulmonary infections due to impaired cough reflex and difficulty with clearing secretions. The weakness and wasting of respiratory muscles can lead to ineffective cough and impaired clearance of secretions, increasing the risk of pneumonia and other pulmonary infections. Therefore, pulmonary infections are the most common cause of death in these patients.

Pseudorosettes refer to a histological pattern seen in certain tumors, where tumor cells surround a central structure, resembling a rosette-like arrangement. This pattern is commonly observed in tumors such as ependymomas, which can occur in the medulla region and spread to the ventricles. Therefore, the presence of pseudorosettes in the tumor suggests a diagnosis of ependymoma, which is consistent with the given clinical scenario.

The correct answer is three of the above (frontal, caudate, and putamen). The symptoms described in the question, including involuntary movement, cognitive function impairment, and severe emotional disturbance, are characteristic of Huntington's disease. This neurodegenerative disorder primarily affects the basal ganglia, which includes the caudate and putamen. Additionally, the frontal cortex is also commonly affected in Huntington's disease. The amygdala, although involved in emotional processing, is not specifically mentioned in the symptoms and may not be directly related to the atrophy seen in this condition.

The most likely etiological agent in this case is Streptococci. The presence of a lesion with a center that has undergone liquifactive necrosis and a surrounding fibrous capsule suggests a chronic infection. Streptococci are known to cause chronic infections, including brain abscesses, which can lead to increased intracranial pressure. Bacteroides fragilis is more commonly associated with intra-abdominal infections, and Mycobacterium tuberculosis typically causes granulomatous inflammation rather than liquifactive necrosis. Therefore, Streptococci is the most probable cause in this scenario.

The correct answer is "All but choice D." This means that all of the options mentioned (microglia, neurophagia, multinucleate giant cell involvement) are common features of the patient's disease, except for Cowdry Type A inclusion bodies. These features suggest a neurodegenerative disorder, possibly a viral encephalitis or multiple sclerosis. The absence of bacteria in the CSF, along with increased protein levels and normal glucose levels, further supports a non-infectious inflammatory process.

The patient's symptoms of rapidly progressive dementia and myoclonus, along with the recent corneal transplantation, suggest a possible diagnosis of Creutzfeldt-Jakob disease (CJD). CJD is a rare, degenerative neurological disorder caused by abnormal proteins called prions (PrPs). The presence of PrPs plaques and spongiform degeneration in the brain tissue is characteristic of CJD. Therefore, the pathologist would most likely see PrPs plaques and spongiform degeneration in the brain tissue sample.

The correct answer is degeneration of neurons in the medial dorsal nucleus of the thalamus. Truncal ataxia, unsteady gait, and nystagmus are characteristic symptoms of Wernicke-Korsakoff syndrome, which is caused by thiamine deficiency due to chronic alcohol abuse. The degeneration of neurons in the medial dorsal nucleus of the thalamus is a key histological feature of this disorder. This degeneration disrupts the connections between the thalamus and other areas of the brain, leading to the symptoms observed in the patient.

The presence of gray plaques around the ventricles suggests that the patient may have multiple sclerosis (MS). MS is characterized by the destruction of myelin, the protective covering of nerve fibers in the central nervous system. Y globulins, also known as immunoglobulin G (IgG), are typically elevated in MS due to the immune response against myelin. Therefore, Y globulins would most likely be elevated in this patient's disease.

In this case, the correct answer is B cells. B cells are commonly seen in lymphomas, which can occur in patients with AIDS. Increased intracranial pressure and difficulty seeing are symptoms commonly associated with lymphomas involving the central nervous system. B cells are a type of white blood cell that play a crucial role in the immune response, and their abnormal growth can lead to the development of tumors.

The patient’s symptoms suggest Parkinson’s disease, which is characterized by slowness of movement (bradykinesia), rigidity, resting tremor, stooped posture, and often dementia. Key pathological features of Parkinson’s include loss of pigmentation in the substantia nigra, presence of Lewy bodies, possible contribution from oxidative stress, and sometimes links to viral encephalopathy.



However, neurofibrillary tangles are hallmark features of Alzheimer’s disease, not Parkinson’s. Thus, they are not characteristic of this condition.

The given correct answer is "None of the above". This means that all of the options listed (Ab deposition, Tau proteins, Senile plaques, and Hirano bodies) are key features of the disease associated with the APP gene mutation. This suggests that all of these features are present in the patient's condition, indicating a likely diagnosis of Alzheimer's disease.

Spindle shaped astrocytes and prominent Rosenthal fibers are characteristic histopathological features seen in all three types of astrocytomas mentioned in the options. Juvenile Pilocytic Astrocytoma is a low-grade tumor commonly seen in children and young adults, Multiforme Glioblastoma is a high-grade malignant tumor with aggressive behavior, and Fibrillary Astrocytoma is an intermediate-grade tumor. These features help in distinguishing astrocytomas from other types of brain tumors.

Subdural hematomas involve bridging veins, which are small veins that connect the surface of the brain to larger veins within the skull. These veins are susceptible to injury and can rupture, leading to the accumulation of blood between the brain and its outer covering, the dura mater. Communicating veins also play a role in subdural hematomas by allowing blood to flow between different regions of the brain. Vena cavas, on the other hand, are large veins that carry deoxygenated blood from the body to the heart and are not directly involved in subdural hematomas.