Path Labs - Brain & Behaviour Block - Neuropathology
Department of Pathology & Laboratory Medicine
Case 1
This 48 year old male who was previously healthy, complained of the sudden onset of excruciating headaches and within a few seconds became unconscious. He was brought to the emergency room where he was found to be unconscious, not responding to verbal or painful stimuli. There were no localizing neurologic signs and the general physical examination was unremarkable. There was nuchal rigidity noted on attempting to flex the neck.
Q1. What is your differential diagnosis?
Unfortunately, the patient did not recover and died several days after admission. The gross appearance of the brain is shown in Figure 1-1.
Q2. Describe the abnormality.
The blood was removed to display the Circle of Willis (Figure 1-2).
Q3. Do you see any abnormality in the Circle of Willis?
A section through the lesion and the vessel from which it arises, stained for elastic (van Gieson stain) is shown in (Figure 1-3).
Q4. What is the abnormality? What are possible causes of hemoptysis?
Case 2
This 68 year old single male had a long standing history of hypertension, complicated by evidence of left ventricular hypertrophy on the electrocardiogram. There was also a 5 year history of angina.
He suddenly developed headache and over a period of 15 minutes developed weakness of the left side of the body and face and then became increasingly obtunded. An ambulance was called and when the ambulance attendants arrived he was found to be deeply unconscious. En route to the hospital he had a cardio-respiratory arrest from which he could not be resuscitated.
Q1. What do you think is the most likely diagnosis?
Figure 2-1 shows a coronal section through the brain.
Q2. What is the abnormality?
Q3. What is the most likely etiology?
Q4. What are some other possible causes?
Case 3
Q1. What is the abnormality seen in Figure 3-1 and Figure 3-2?
Q2. Figure 3-3 (hematoxylin and eosin) and Figure 3-4 (elastic stain) show microscopic sections of this lesion. What do you see?
Q3. What would you predict would be the clinical manifestations of this lesion?
Case 4
Q1. Identify the abnormality in these coronal sections of the cerebral hemisphere shown in Figure 4-1.
Q2. Figure 4-2 shows the microscopic details of the lesion in Figure 4-1. Can you identify the main cellular components of the lesion?
Q3. Could you estimate the age of the lesion from its gross and microscopic appearance?
Q4. Figure 4-3 is the microcopic picture of a similar but older lesion in the cerebral hemisphere of another patient. The section has been stained with phosphotungstic acid hematoxylin that highlights reactive astrocytes (gliosis).