Neuropathology Practice Questions

Q: Which of the following statements about metastases of malignant tumors of the brain is TRUE?

All of the above.. Primary malignant brain tumors (like Medulloblastoma or Glioblastoma) rarely metastasize outside the CNS because the brain lacks a traditional lymphatic system and is protected by the blood-brain barrier. However, spread can occur through specific pathways. [1] **Explanation of Options:** * **Option A (Drop Metastases):** Tumors arising near the ventricles or subarachnoid space (e.g., Medulloblastoma, Ependymoma) can shed cells into the Cerebrospinal Fluid (CSF). Gravity carries these cells to the lower spinal cord (cauda equina), forming "drop metastases." [1] * **Option B (Lymph Node Metastases):** While the brain lacks lymphatics, surgery or trauma can disrupt the blood-brain barrier and create a communication between the tumor and extracranial tissues. This allows tumor cells to reach systemic lymphatics, leading to regional lymph node involvement. * **Option C (Man-made Shunts):** Ventriculoperitoneal (VP) shunts, used to treat hydrocephalus, provide a physical conduit for tumor cells. Cells can travel through the tubing and seed the peritoneal cavity (extracranial spread). **Conclusion:** Since all three mechanisms are recognized pathways for the spread of malignant CNS tumors, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Medulloblastoma** is the most common tumor to show "drop metastases" to the spinal cord. [1] * **Glioblastoma Multiforme (GBM)** is the most common primary brain tumor to show extracranial spread (usually after surgery). * **Systemic metastasis** of primary CNS tumors is extremely rare (<1%) due to the rapid clinical course and anatomical barriers. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1314-1315.

Q: The given lesion is best associated with which of the following conditions?

Atherosclerotic (ischemic) stroke. ***Atherosclerotic (ischemic) stroke*** • The large **cystic cavity** with **liquefactive necrosis** in the **MCA territory** is characteristic of a chronic atherosclerotic infarct where necrotic tissue has been cleared. • **Single-territory involvement** and the **well-demarcated** nature of the lesion strongly suggest **thrombotic occlusion** of a major cerebral artery due to atherosclerosis. *Embolic stroke* • Typically produces **multiple small infarcts** scattered across different vascular territories rather than a single large cavity. • Often shows **hemorrhagic transformation** with petechial bleeding, which is not evident in this purely cystic lesion. *Hypertensive bleed* • Usually occurs in the **basal ganglia**, **thalamus**, or **brainstem** due to rupture of small penetrating arteries. • Presents as **acute hemorrhage** with blood clot formation, not as a **cystic cavity** with liquefactive necrosis. *Ruptured berry aneurysm* • Causes **subarachnoid hemorrhage** with blood in the **subarachnoid space** around the brain surface. • Does not typically produce **parenchymal cystic cavities** but rather results in **acute bleeding** into CSF spaces.

Q: Wilsons disease primarily affects which part of the CNS?

Basal ganglia. Wilson’s disease (Hepatolenticular degeneration) is an autosomal recessive disorder caused by a mutation in the **ATP7B gene** on chromosome 13. This leads to impaired biliary copper excretion and the subsequent accumulation of toxic copper in various tissues, most notably the liver and the brain [1]. **Why Basal Ganglia is correct:** The **Basal Ganglia**, specifically the **Putamen** (part of the lentiform nucleus), is the primary site of copper deposition in the Central Nervous System. This selective vulnerability leads to the characteristic "Lenticular degeneration." Damage here manifests as extrapyramidal symptoms, including tremors (wing-beating), dystonia, parkinsonism, and dysarthria [1]. **Why other options are incorrect:** * **Cerebrum:** While cortical atrophy can occur in advanced stages, it is secondary to the primary subcortical pathology. * **Cerebellum:** Though ataxia can be a clinical feature, the cerebellum is not the primary or most characteristic site of copper deposition. * **Pons:** The pons is typically spared in Wilson’s disease. Pontine lesions are more characteristic of Central Pontine Myelinolysis. **High-Yield Clinical Pearls for NEET-PG:** * **MRI Brain:** The classic finding is the **"Face of the Giant Panda"** sign in the midbrain (due to sparing of the red nuclei and substantia nigra pars reticulata). * **Kayser-Fleischer (KF) Rings:** Copper deposition in the **Descemet’s membrane** of the cornea; seen in 95% of neurological cases. * **Diagnosis:** Decreased serum ceruloplasmin (<20 mg/dL) and increased 24-hour urinary copper excretion. * **Treatment:** Chelating agents like **D-Penicillamine** (first-line) or Trientine, and Zinc (to prevent absorption).

Q: Which of the following statements is not true about Glioblastoma?

It belongs to WHO grade 3 Astrocytoma. **Explanation:** **1. Why Option C is the Correct (False) Statement:** Glioblastoma (GBM) is classified as a **WHO Grade 4** tumor, not Grade 3. It is the most aggressive and common primary malignant brain tumor in adults. According to the updated WHO classification, Grade 3 astrocytomas are termed "Anaplastic Astrocytomas." The hallmark that upgrades an astrocytoma to Grade 4 (GBM) is the presence of **necrosis** and/or **microvascular proliferation** [1]. **2. Analysis of Other Options:** * **Option A (Butterfly Tumor):** GBM frequently crosses the midline via the **corpus callosum**, involving both cerebral hemispheres. On imaging, this symmetrical spread resembles the wings of a butterfly, hence the name "Butterfly Glioma." * **Option B (Frontal Lobe):** While GBM can occur anywhere in the CNS, the **frontal and temporal lobes** are the most common supratentorial locations. * **Option D (Characteristic Features):** Histopathology of GBM is classic for **Serpentine (palisading) necrosis**, where areas of dead tissue are surrounded by crowded tumor cells, and **Glomeruloid bodies**, which are tufts of multilayered, proliferating endothelial cells resembling renal glomeruli [1]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Molecular Marker:** IDH-wildtype status is now a defining feature of primary Glioblastoma in the latest WHO classification. * **Age Group:** Most common in the 5th to 7th decades of life [2]. * **Genetic Associations:** Often associated with **EGFR amplification** and PTEN mutations [2]. * **Prognosis:** Poor, despite aggressive surgery, radiotherapy, and chemotherapy (Temozolomide) [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1310-1311. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1308-1310.

Question 1

Which of the following tumors is associated with drop metastasis?

Accepted Answer

Medulloblastoma

Answer

Astrocytoma

Answer

Ependymoma

Answer

Oligodendroglioma

Question 2

Which of the following statements about metastases of malignant tumors of the brain is TRUE?

Accepted Answer

All of the above.

Answer

Drop metastases can occur in the spinal cord.

Answer

Lymph node metastases can occur in patients who have undergone brain surgery.

Answer

Metastases can occur through man-made shunts.

Question 3

The given lesion is best associated with which of the following conditions?

Accepted Answer

Atherosclerotic (ischemic) stroke

Answer

Embolic stroke

Answer

Hypertensive bleed

Answer

Ruptured berry aneurysm

Question 4

Wilsons disease primarily affects which part of the CNS?

Accepted Answer

Basal ganglia

Answer

Cerebrum

Answer

Cerebellum

Answer

Pons

Question 5

What is the pathological change observed in the brain in cerebral malaria?

Accepted Answer

Microvascular occlusion

Answer

Cerebral edema

Answer

Increased intracranial pressure

Answer

Space occupying lesion

Question 6

Inclusions in oligodendrocytes are a characteristic feature of which condition?

Accepted Answer

Progressive multifocal leukoencephalopathy (PML)

Answer

Creutzfeldt-Jakob disease

Answer

Chronic inflammatory demyelinating polyneuropathy (CIDP)

Answer

Herpes simplex virus (HSV) encephalitis

Question 7

What genetic mutation leads to Duchenne Muscular Dystrophy?

Accepted Answer

Duchenne Muscular Dystrophy

Answer

Myasthenia gravis

Answer

Motor neuron disease

Answer

Poliomyelitis

Question 8

All of the following are congenital myopathies EXCEPT:

Accepted Answer

Mitochondrial myopathy

Answer

Nemaline myopathy

Answer

Central core disease

Answer

Centronuclear myopathy

Question 9

Neurofibrillary tangles, senile plaques, and amyloid angiopathy are associated with which of the following causes of dementia?

Accepted Answer

Alzheimer's disease

Answer

Creutzfeldt-Jakob disease

Answer

Vascular dementia

Answer

Niemann-Pick disease

Question 10

Which of the following statements is not true about Glioblastoma?

Accepted Answer

It belongs to WHO grade 3 Astrocytoma

Answer

Also known as Butterfly tumor

Answer

Frontal lobe of the brain is a common location

Answer

Serpentine necrosis and glomeruloid bodies are characteristic features

Neuropathology — MCQs

Neuropathology — MCQs

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