Neuropathology Lab I
MHD II
Case 1
Normal brain – cerebral cortex H&E stain. Low power
Q1. Identify the gray matter and the white matter
Q2. Identify the arachnoid and the subarachnoid space
Identify blood vessels in the subarachnoid space
Q3. What cell type is highlighted by the blue stars? What is its characteristic
histologic features?
Q4. What cell type are the arrows pointing to? Describe its characteristic
histologic features. What is its function?
GFAP stain
Q5 What is the predominant cell type in the high power section? What is its
characteristic histologic features? What is its function?
Case 2
History
Cc: Progressive ataxia, weakness of limbs and blurred
vision with remissions and relapses of 5 years’ duration
HPI: The patient is a 40-year old woman who was well
until 5 years ago, when following a “flu”, she developed
tremors of her arms and loss of balance while walking or
standing. The symptoms improved but 6 months later
she complained of blurred vision in her right eye.
Approximately 1 month later she had another episode of
ataxia and weakness and was seen in the ED.
Physical exam: BP 110/80; HR 80/minute and regular; respiratory rate
20/minute; temperature 990F
Head/Neck: No facial asymmetry. Extraocular movements are full. Visual
acuity: Right 20/200; Left 20/20. The right pupil is 5mm in diameter and does
not react to direct light.
Fundus exam: normal
Heart, lung, abdominal exams: normal
Neurological exam: Mental status – oriented to time, person, and place. The
patient has ataxia and dysarthria and is unable to stand or walk without
support.
Motor Exam: Weakness of lower extremities, right 4/5; left 2/5; Reflexes:
Deep tendon reflexes are hyperactive; Babinski sign in present on the left
side.
Sensory Exam: decreased vibration and position sense to both legs, pain and
touch are intact
Q1 Develop a problem list
Q2 Can you name a single lesion in the nervous
system which could explain this patient’s
neurologic findings? Why or why not?
Q3 Cite data which support of refute the
following differential diagnoses:
 Amyotrophic lateral sclerosis (ALS)
 Cervical spondylosis with myelopathy
 Benign tumor of spinal cord
 Systemic Lupus Erythematosus (SLE)
 Multiple Sclerosis
Diagnostic evaluation:
Complete blood count (CBC), Basic metabolic
panel (BMP) and urinalysis are within normal
limits
An MRI of the brain is performed.
Q4 What is the primary abnormal
finding?
Lumbar Puncture is performed:
CSF examination:
Protein 65mg/dL (normal 15-45 mg/dL)
Glucose 70mg/dL (serum glucose 90mg/dL)
Cells : Lymphocytes 50
Gammaglobulin (IgG) is increased; oligoclonal
bands are identified
Q5 Interpret the CSF. Explain what “oligoclonal
bands” are and the significance of their
presence in this case.
Q6 Based on the provided clinical and
diagnostic data, what diagnosis do you favor?
Q7 Describe the gross pathologic findings. Do
they correlate with the MRI findings?
Q8 Describe the gross
findings.
Luxol Fast Blue stain:
stains myelin blue
Ventricle
Q9 Describe the findings.
Correlate with the gross
and radiologic findings.
Q10 Identify the structure and the pathology. What is
its relevance to the pathologic process we are
discussing? Do the findings correlate with the clinical
findings? (Myelin stain)
Q11 Describe the histopathologic hallmarks of
the disease.
Describe the key findings in each of the
following histologic sections (A-D)
A
B
What cell type is lost in this process? What is the predominant cell type in the circle?
C
D
What is the cell
type? What is
in cytoplasm?
Case 2 Summary
Q12. Describe typical location of the pathology
for this disease process (where is the pathology
in the CNS, brain?, spinal cord?, white matter?,
grey matter?).
What is the pathomechanism of the disease?
What is the main pathologic process?
Case 3
HISTORY
A 20 year old male college student was found in his
dorm room in bed by his roommates complaining of
headache, nausea, and photosensitivity. When the
patient started vomiting and appeared confused,
his roommates brought him to the emergency
department
On presentation his temperature was 40.10C.
He was somnolent, but reacted to painful stimuli.
He had nuchal rigidity.
Funduscopic exam is performed
Patient
Q1 What is the abnormality?
Normal
Q2. Develop a problem list.
Q3. Develop a differential diagnosis. Which
diagnosis do you favor?
Q4. What diagnostic tests would you order?
After further diagnostic tests, therapy was
initiated. However, the patient’s mental status
worsened over the next several hours. He
required intubation and mechanical ventilation.
Skin exam
Q5 Describe the findings.
Hospital Day 1
Hospital day 3
The patient’s condition continued to deteriorate.
He died on hospital day #3 despite maximal
attempts at resuscitation.
An autopsy was performed
Q6. Describe the gross findings.
What is the arrow highlighting?
What structure is the forceps on?
Low power H& E Section.
Q6 Describe the findings. Correlate with the gross findings.
Normal
Q7 Describe the higher power histologic findings
Q8 Describe the findings on high power.
Q9 What is your diagnosis?
Q10 Correlate the pathologic findings with the
findings you suspect were likely present on
examination of the CSF.
Q11 What is/are the most likely etiologic agent(s)
of this disease process in this patient?
Adrenal glands. Q12 – Describe the pathologic findings.
ADRENALS
clinically?
How did this process manifest
Q13 Summarize the cause of death in this
patient.
Case 4
History
A 34 year old man fell from his bicycle striking his
head on the curb. A passerby witnessed a brief
period of unconsciousness lasting approximately 30
seconds. He regained consciousness but remained
somewhat confused. When paramedics arrived, he
was still disoriented but was moving all extremities
on command and had normally reactive pupils. He
was placed on a spine board and in a stiff cervical
collar and was transported to the hospital.
Physical exam: BP 126/78, HR 82/minute and
regular; respiratory rate 20/minute;
temperature 990F
Right frontotemporal scalp hematoma was
noted.
Patient was confused with an initial GCS of 14.
Q1 What is your differential diagnosis?
Q2 What diagnostic tests are indicated?
Q3 Describe the findings.
Q4 What is your diagnosis?
Q5 What is the treatment?
Q6 What are potential complications of this
disease process?
Q7. Describe the gross findings.
Q6 Describe the pathogenesis of this disease
process. What is the most common source of
bleeding?
Case 5
Additional Examples of Traumatic Brain Injury:
Patient 1
Q1 Describe the gross findings. What may have been the
cause? What clinical or physical exam findings may have been
seen in this patient?
Patient 2
Q2. Describe the gross
findings.
What scenario(s) may
have led to the
development
of these findings?
Patient 3
Q3. Describe the gross findings. Be certain to comment on the particular
location of the abnormal findings.
Patient 3.
Q4 Describe the histologic findings on this golgi (silver)
stained section.
Q5 What is the most likely mechanism/cause of
patient 3’s pathology? Describe the likely
clinical condition of this patient.