“Within our minds and personalities, there is great

potential strength and ability. Prayer helps us tap and develop

these powers.” - Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.

Quick Pathology Review

Shashidhar Venkatesh MurthyA/Prof.& Head of PathologySchool of Medicine & Dentistry James Cook University Australia.

Pathology of Stroke.

System : Central Nervous SystemClass : Vascular disorders.Topic : Pathology of stroke.

CPC 34- CNS-Stroke/CVA, Vascular disorders

Major CLI:• Stroke – Cerebrovascular accident  - Types, etiology,

pathogenesis, clinical features and complications. • TIA – Transient Ischemic Attack – Pathophysiology &

clinical features. • Hypertension Patho-physiology & complications (Macro

& Microvascular) – self study.

Minor CLI:• AV malformation, congenital Aneurysms.• Global ischemia and CNS manifestations.• Venous infarcts.• Lacunar infarcts.

A. B. C. D. E.

97%

0% 3%0%0%

A 72 year old woman with a one year history of declining memory developed sudden headache and decreased consciousness and collapsed while washing dishes. Image shows autopsy appearance of her brain. What is the most likely diagnosis ?

1. If patient had lived, What neurological deficits she would show?2. What is the cause of her death?3. List other CNS manifestations of hypertension?

A. Hypertension.

B. Head Injury.

C. Carotid Artery thrombosis.

D. Ruptured AVM.

E. Septicemia.

A. B. C. D. E.

2%

7%

18%

33%

40%

A 58 year old man fell from his house roof while trying to fix a leak and hit his front of head against ground. He was unconscious for an hour then regained consciousness but gradually detiriorated over 10 days and died in the ER due to cardiorespiratory failure. At autopsy greyish tissue was biopsied and image shows microscopic appearance. What is the most likely diagnosis?

1. List microscopic features at 1 hour, 1 week, 4 week of a infarct?2. List Laboratory findings expected in her?

A. Astrocytoma Grade-1.

B. Glioblastoma multiforme.

C. Healing reactive gliosis.

D. Red neurons of infarction.

E. Liquifactive necrosis.

A. B. C. D. E.

9%

89%

0%2%0%

68 year hypertensive, diabetic with atherosclerosis. Image shows section of brain. Which artery is most likely involved?.http://neuropathology.neoucom.edu/test2/2test.html

1. What is the pathogenesis: Hemorrhage, Embolism or thrombosis?2. Differentiate each type of pathogenesis?3. List steps in the progress of a infarct 1D, 1W, 4W (gross & microscopy)?

A. ACA.

B. MCA

C. PCA.

D. Veins

E. PICA, basilar, or vertebral artery.

A. B. C. D. E.

37%

5%

47%

9%

2%

A 15 year old male with SLE had decreased consciousness, bilateral lower extremity weakness, and the MRI changes illustrated below. Symptoms improved somewhat but a follow-up MRI showed residual encephalomalacia. The lesions are most likely caused by?

ANSWER: The T2 MRI shows bilateral parasagittal lesions, consistent with venous infarcts. The most likely etiology is superior sagittal sinus thrombosis associated with the anticardiolipin syndrome.

A. Lupus vasculitis.

B. Embolism from endocarditis.

C. Borderzone Ischemia.

D. Multiple sclerosis.

E. Superior sagittal sinus thrombosis.

A. B. C. D. E.

0% 2%

19%

0%

79%

68 year hypertensive, diabetic with atherosclerosis. Image shows section of brain. Which artery is most likely involved?.

1. What is the pathogenesis: Hemorrhage, Embolism or thrombosis?2. Differentiate each type of pathogenesis?3. List steps in the progress of a infarct 1D, 1W, 4W (gross & microscopy)?

A. ACA.

B. MCA

C. PCA.

D. Veins

E. PICA, basilar, or vertebral artery.

?

A. B. C. D. E.

94%

2% 0%2%2%

68 year hypertensive, diabetic with atherosclerosis. Image shows section of brain. Which artery is most likely involved?

1. List 3 common clinical features? List 3 common etiologic factors?2. What is the pathogenesis ? 3. List steps in the progress of a infarct 1D, 1W, 4W (gross & microscopy)?

A. ACA.

B. MCA

C. PCA.

D. Veins

E. PICA, basilar, or vertebral artery.

A. B. C. D. E.

0%

28%

3%

63%

6%

77 year man P/H poorly controlled hypertension develops a sudden, severe headache, followed by obtundation. His head CT is shown. Most likely clinical feature?

?

Pathophysiology: small penetrating arterioles arteriolosclerosis Charcot Bouchard microaneurysms rupture hemorrhage. Prognosis poor in basal ganglia. Better in cerebellum.

A. Embolic stroke.

B. Hemorrhagic stroke.

C. Lacunar infarct.

D. Ruptured berry aneurysm.

E. AV malformation..

A. B. C. D. E.

0%

30%

50%

0%

20%

68 year hypertensive, diabetic with atherosclerosis. Image shows section of brain. Which artery is most likely involved?

Section of medulla stained for myelin. Demyelenated wedge on the left is lateral medullary infarct (occlusion of PICA), branch of vertebral or the basilar artery. What are the typical clinical features?

?

A. ACA.

B. MCA

C. PCA.

D. Veins

E. PICA,

A. B. C. D. E.

7%

51%

5%

0%

36%

68 year hypertensive, diabetic with atherosclerosis. Image shows section of brain. Most likely clinical feature?

the lesion is a lacunar infarct. Because of its small volume, slow occlusion it does not cause sudden or life threatening cerebral edema. What are the typical clinical features? Common etiology? Common 5 presentations?

?A. Sudden paralysis.

B. Dementia

C. Progressive weakness.

D. Loss of consciousness

E. Sudden blindness.

A. B. C. D. E.

2% 4%

88%

6%0%

71 year male, hypertensive, diabetic with atherosclerosis. Sudden loss of consciousness and fall. Image shows section of his brain. Most likely clinical feature?

The lesion is an MCA infarct and will cause contralateral paralysis of the face and arm.

?A. Hemiparesis leg.

B. Visual deficit (cortical blind.)

C. Anosmia.

D. Memory deficit

E. Hemiparesis face and arm.

A. B. C. D. E.

15%

23%

58%

4%0%

A 43 year old man. No significant past medical history has a sudden new-onset grand mal seizure followed by loss of consciousness for few minutes then he recovers. He had recurrence of symptoms 17 months later. During workup he had angiogram of his left ICA followed by surgery. Image shows appearance of his lesions. What is the most likely diagnosis?

Pathophysiology: Harmartoma of bloodvessels in brain. (developmental defect). Rupture, bleed, mass lesion, seizure etc. Gross: tumor like collection of Large irregular dilated cluster of blood vessels.

A. Charcot Bouchard aneurysm.

B. Berry aneurysms of ICA.

C. Atherosclerosis of ICA.

D. Ruptured berry aneurysm.

E. Vascular malformation.

“Man needs his difficulties because they are necessary to enjoy

success.”

- Wings of Fire: An Autobiography of Dr. APJ Abdul Kalam.