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Basic Neuropathology 9

 
Basic Neuropathology 7

 
Basic Neuropathology 8

 
Basic Neuropathology 6

 
Myelin 11

 
Neuromuscular 09
Courtesy of Dr. Mark Cohen Diseases characterized by these ultrastructural features on muscle biopsy may show all of the following, EXCEPT:
 
Adult Brain Tumor Pathology 01
Courtesy of Dr. Mark Cohen A 50 year old woman presents with slowly worsening seizures over 9 months. Imaging of the head reveals a mass lesion. The lesion is surgically resected, and an H&E preparation of the tumor is shown in the image above.What kind of tumor is this
 
Werdnig-Hoffman Disease
Which of the following statements about Werdnig-Hoffman disease is most accurate
 
Toxicity and Characteristic Pathology 02
Courtesy of Dr. Mark Cohen A 25 year old woman in previously good health is found at home, comatose and with bright red skin.  After a few days in the ICU, the patient expires.  An autopsy is performed. The brain is shown in the image above. What was the cause of death
 
Pediatric Brain Tumor Pathology 01
A developmentally delayed 4 year-old male presents with several months of worsening seizures and headaches. A head CT reveals a large mass with areas of calcification. The mass is removed surgically. The image above shows an H&E stain of a section taken from the mass...
 
Neuromuscular Disorders 01
The Gomori trichrome stained muscle biopsy shown above is most consistent with which of the following disorders
 
Basic Neuropathology 05
This is a photomicrograph of a brain biopsy stained with H&E. What is the abnormal finding in this slide
 
Basic Neuropathology 04
This is a photomicrograph of a brain biopsy stained with H&E. What are the abnormal structures shown in this slide called
 
Pathology of primary CNS angiitis
Which of the following pathological findings is most characteristic of primary angiitis of the CNS
 
Pathology of giant cell arteritis
Which of the following pathological findings is most characteristic of giant cell arteritis
 
Pathology of polyarteritis nodosa
Which of the following pathological findings is most characteristic of polyarteritis nodosa
 
Pathology of CADASIL
Which of the following pathological findings is most characteristic of CADASIL
 
Toxicity and Characteristic Pathology 01
A 23 year old man in previously good health is found at home, comatose and with bright red skin.  After a few days in the ICU, the patient expires.  Carbon monoxide poisoning is the suspected cause of death. On autopsy, what findings in the brain can you expect to see 
 
Basic Neuropathology 03
Loss of the cells shown in this image is associated with which of the following exam findings
 
Basic Neuropathology 02
Which of the following statements is most accurate regarding the space indicated by the unnecessarily large red arrow in the image above
 
Basic Neuropathology 01
What are Creutzfeldt cells
 
Dementia 02
A 80 year-old male presents to your office accompanied by his daughter, who provides most of the history. The daughter states that for the past 5 years, the patient has been having progressively worsening memory problems, has been seeing people in the room...
 
Guess the disease!
GUESS WHAT I'M THINKING! I'm thinking of a variant of multiple sclerosis (MS), in which optic neuritis and transverse myelitis occur together, or at least within weeks of each other. The transverse myelitis frequently leads to necrosis, and is thus...
 
Pathology in Alzheimer dementia 01
Courtesy of National Institute of AgingThis pathology slide was obtained from an adult patient. Which of the following statements about this image is true
 
CNS tumor pathology
Which of the following is most accurate regarding CNS tumor pathology
 
Pathology in Ischemic Stroke 03
A patient presents with an acute ischemic stroke and dies 6 months later. Of the following choices, which is most likely to be seen on pathological examination of the brain at autopsy
 
Pathology in Ischemic Stroke 02
A patient presents with an acute ischemic stroke and dies 1 week later. Of the following choices, which is most likely to be seen on pathological examination of the brain at autopsy
 
Pathology in Ischemic Stroke 01
A patient presents with an acute ischemic stroke and dies 18 hours after onset of symptoms. Of the following choices, which is most likely to be seen on pathology
 



User Forums and Comments



Comment
wonderful sirA gr8 ideasir wat is the scope of doiong Neurology after doing Neuropathology
 
Why are you doing this?
Other versions of this question have included, Why the hell do you spend so much time on this and What does your wife thinkWell, here's the deal.  I've been programming since I was in grade school (back then, it was Fortran on punchcards).  Some people golf...
 
laminar necrosis
Hoping gliageek can field this one, please:I'm reading about laminar necrosis in anoxia/hypoxia, which is defined as damage to cortical layers III and V, specifically extensive eosinophilic degeneration and death, with sparing of the other neocortical layers...
 
Re: how do we tell the difference between DNT and oligodendrogli
Ingy -Thanks for the excellent question.Admittedly, oligodendroglioma and dysembryoplastic neuroepithelial tumor (DNT) look a lot alike, and you might not be able to tell the difference between them if all you saw was one slide.  For examination purposes,...
 
Re: Re: Re: Most Important Neuropathology Topics for Neurology R
how do we tell the difference between DNT and oligodendroglioma, this egg like and fried egg apperance
 
Re: Re: Most Important Neuropathology Topics for Neurology Resid
PKAN = Pantothenate kinase-associated neurodegeneration.This is the ailment formerly known as Hallervorden-Spatz syndrome.  Since Hallervorden and Spatz were involved in Nazi atrocities, they don't get to keep the disease anymore.  
 
Re: Most Important Neuropathology Topics for Neurology Residents
PKAN
 
Re: Most Important Neuropathology Topics for Neurology Residents
Here's a bit on pseudopallisading necrosis in glioblastoma.
 
Most Important Neuropathology Topics for Neurology Residents
Okay, so here's the scenario.You're a neurology resident, and you're studying for some big boards-type exam.  FrontalCortex.com has hundreds and hundreds of neuropathology images and stuff, but you want to focus on the high-yield neuropathology...
 
Another Pathology Site
Another pathology site, where users can share path images and videos. Remember, you can do this on FrontalCortex, too!
 
Lots of New Stuff
There are a lot of new features on FrontalCortex which have been added over the past few months.Most significantly, we've added the ability for users to create and maintain multimedia online courses.  Check out the courses tab.  You'll find an online...
 
Fantastic!
Thanks to gliageek for the incredible job on this highly informative presentation on the pathology of meningiomas. Highly recommended for anyone wanting to learn more about meningiomas.
 
Comment
The only blog about neuropathology! It contains web links of interest to neurologists.
 
Comment
Neuropathology cases from the VA
 
Inborn Errors of Metabolism
Inborn errors of metabolism are defined as abnormalities of the synthesis, transport, or turnover of nutritional and cellular compounds. Individually, they are rare, but as a group, their incidence is about 1 in 1,000. They are typically genetic defects in metabolic enzymes, and as such are inherited...
 
Ohio University Neuropathology test questions
Good stuff!
 
International Society of Neuropathology Case of the Month.
Pathology! I don't know about you, but I have a hard time finding good path cases. This site is chock full of 'em.
 
Re: Useful Links Forum
NeuropathologyWeb.org - a nice page with lots of teaching materials and study questions, on neuropathology.
 



Online Course Content



Neuropathology for Neurology Residents
Welcome to neuropathology for neurology residents.This online course was developed by Dr. Mark Cohen and Dr. Doug Miles.  It is intended to be used as the cornerstone for a resident-level neuropathology course, in conjunction with assigned textbook reading...
 
Neuropathology Board Review part 6 (video)

 
Neuropathology Board Review part 5 (video)

 
Neuropathology Board Review part 4 (video)

 
Neuropathology Board Review part 3 (video)

 
Neuropathology Board Review part 2 (video)

 
Neuropathology Board Review part 1 (video)

 
Neuropathology Board Review (video)

 
Neuropathology Board Review
WelcomeWe are proud to present a series of videos by Dr. Mark Cohen, providing an overview of topics in neuropathology.When you click the thumbnails, the videos may begin playing in small size - you can enlarge them by clicking the square in the upper right hand corner of each video...
 
Online courses
On FrontalCortex.com, you can create a collection of multimedia resources organized into a coherent structure focused on one topic.This is considered an online course. An example of this is the neuropathology course, or the EMG course. Mixing with Face-to-Face...
 
Recorded Lectures and Flash Presentations
At this time, FrontalCortex.com has at least a dozen full-length lectures, featuring slides, recorded voice, and some basic user interactive features (Skip ahead, go back, etc).Great deal of interest from some medical instructors.  In residency programs,...
 
Normal skeletal muscle, H&E stained section of paraffin embedded tissue x 100 (image)

 
Normal skeletal muscle, H&E stained frozen section x 100 (image)

 
Type 2 prion disease, cerebellum, 3F4 immunohistochemical staining x 20 (image)

 
Type 2 prion disease, immunohistochemical stains sectioned from hippocampus. (image)

 
Frontotemporal lobar degeneration, ubiquitin immunoreactivity within dentate gyrus of hippocampus. (image)

 
Necrosis of gray and white matter, coronal section (image)

 
Prion Infections
Infection without inflammation – Prion diseases    A. PathogenesisHuman spongiform encephalopathies are a group of disorders that share certain clinical, pathological, and pathogenetic features. All cause a progressive, fatal, dementing illness; most...
 
Viral Infections
The most common causes of viral meningitis in the U.S. are nonpolio enteroviruses (coxsackie and echovirus), which often occur in summer and early fall. Infection is by the fecal-oral route, with primary viral replication in the GI and upper respiratory tracts...
 
Multiple Sclerosis
Acquired, inflammatory leukoencephalopathiesInflammation may either be related to infection, or indicate the presence of an autoimmune process. Infection of oligodendroglial cells is unusual, and is practically confined to JC virus infection in immunocompromised...
 
Normal samples
In order to recognize pathology, it is necessary to know what normal tissues look like. To that end, we present here a set of slides which depict normal anatomy, both on the gross and microscopic level. Throughout this course, whenever new pathologic concepts...
 
Alzheimer Disease
Alzheimer's Disease is the most common dementing illness and can occur at any age over 30. It tends to affect women more than men, even when survival differences are taken into account. It is relatively uncommon before age 65, affecting about 0.1% of the...
 
Vascular Disease 4: Other topics in vascular disease
Working from the outside in, intracranial hemorrhage may be epidural, subdural, subarachnoid, intraparechymal, or intraventricular in origin (though many do not remain localized to a single compartment). The term “hemorrhagic stroke” only applies to subarachnoid and intraparenchymal hemorrhages...
 
Vascular Disease 3: Vascular anomalies
Arteriovenous malformations (AVMs) are the most clinically significant of the congenital vascular malformations (the others are less likely to become symptomatic and are more frequently incidental findings on examination of the brain for other reasons). ...
 
Vascular Disease 1: Reaction to ischemic injury
There are different types of ischemic injury.  Ischemia can affect the entire brain, or just a particular vascular distribution.  It can be brief, as in a TIA, or it can endure.  The patterns of damage we see in gross and microscopic pathology reflect the focality and temporal course of the ischemia...
 
Viral Encephalitis
A. Herpes Simplex Virus Type 1 Encephalitis 1. Pathogenesis HSV-1 encephalitis is the most common cause of acute sporadic encephalitis in the U.S. It typically causes lip and mouth lesions (herpes labialis and stomatitis). Note the distinction from HSV-2,...
 
The Pathology of Alzheimer Disease
A.     Epidemiology AD is the most common dementing illness and can occur at any age over 30. It tends to affect women more than men, even when survival differences are taken into account. It is relatively uncommon before age 65, affecting about 0.1%...
 
GFAP
Glial fibrillary acidic protein (GFAP) is the major intermediate filament expressed in astrocytes and ependyma.  Immunohistochemical staining with antibodies specific for GFAP consequently highlights these cells. In the examples here, the regions which stain brown indicate the presence of GFAP...
 
H&E - Normal Example (image)

 
Basilar artery thrombosis, ventral surface of brain. (image)

 
Pathology in Ischemic Stroke 03
127
 
Pathology in Ischemic Stroke 02
126
 
Pathology in Ischemic Stroke 01
125
 
Wallenberg Syndrome MRI with arrow (image)

 
Wallenberg Syndrome MRI (image)

 
Giant Cell Arteritis, H&E stain x40 (image)

 
Commonly used stains
In this section, we'll go over some of the more commonly used stains in neuropathology.  Different stains might be used in different tissues.  For example, the Gomorri trichrome stain is especially helpful in muscle to find certain types of myopathy...
 
Other Immune Stains
Immunohistochemical (IHC) staining is the technique of using antibodies against a specific antigen (such as amyloid, CD68, ubiquitin, or GFAP) to label a tissue.  This technique is extremely versatile, since it can be applied to virtually any epitope to which a specific antibody can be created...
 
Electron Microscopy
In pathology-speak, Electron Miscroscopy is often referred to as EM or ultrastructural examination.EM is time consuming and technically challenging, but allows the visualization of structures much, much smaller than anything visible on light miscoscopy. ...
 
COX (Cytochrome Oxidase) Staining
Cytochrome oxidase (cox) is an oxidative enzyme in the electron transport chain.  Staining for cox is a sensitive method to assess capacity for oxidative metabolism. Type I muscle fibers have a higher capacity for oxidative metabolism than type II cells,...
 
NADH
NADH is a marker for oxidative activity.  Histochemical staining for NADH can therefore give an indication of the relative oxitadive activity of a structure.  Among other things, NDAH staining can be used to differentiate Type I from Type II mucle fibers, or show the presence of central cores.
 
ATPase
ATPase stains are histochemical stains to assess the relative function of myofibrillar ATPase.  This is helpful in distinguishing Type I fibers from Type II fibers.ATPase stains differently depending on the pH at which the stain is performed.  At lower pH values (e...
 
H & E
H&E is short for Hematoxylin and Eosin.  The H&E staining method is the most commonly used stain in neuropathology.  It is a simple stain, and provides an excellent first look at the tissue of interest.Hematoxylin as a basic dye, and has an affinity for basophilic structures...
 
H&E Stain of a Pilocytic Astrocytoma (image)

 
Adult Brain Tumor Pathology 01
347
 
Other non-immune stains
These stains are ones that you may come across during your rotation or during your reading, but are less frequently used than the ones discussed elsewhere.These are all tinctorial stains, not immune or histochemical stains.Click any of the images below for...
 
Toxicity and Characteristic Pathology 02
270
 
Toxicity and Characteristic Pathology 01
142
 
Pediatric Brain Tumor Pathology 01
237
 
How to use the microscope
A brief and basic review on the use of the microscope.Many medical schools no longer require their students to learn how to use a microscope.  And yet, you may be in a pathology course where you are expected to look at microscope slides.  So here's a...
 
Basic Neuropathologic Reactions 5 (video)

 
Pathology of Epilepsy (video)

 
Neuromuscular disorders 1: Myopathies and Dystrophies
There is a wide array of pathology associated with nerve and muscle diseases.  This section will go into categories of muscle and nerve disorders, and certain specific disorders in depth.  Try the most recent additions to this section - an overview by jdmiles...
 
Myopathy with Tubular Aggregates
Tubular aggregates are a fairly nonspecific finding.  They are found in many muscle disorders, including perioric paralyses, some myotonic disorders, ond some toxic myopathies. Tubular aggreagates look like this (click to enlarge):    References:Katirji, B...
 
Categories of Congenital Myopathies
The congenital myopathies are genetic diseases resulting in skeletal muscle abnormalities.  They are often apparent at birth, but may not manifest symptoms until later in life. Categorization of Congenital Myopathies Since there is considerable overlap in...
 
Multicore Disease / Minicore Disease
Multicore Disease and Minicore Disease are synonymous terms.The disorder they describe is related to, but distinct from, central core disease.  In central core disease, the mitochondria-lacking cores run the whole length of the muscle fiber.  In minicore...
 
Nemaline Myopathy
Like many of the congenital myopathies, the features of nemaline myopathy tend to be more severe course if the disease initially presents in infancy.  A more moderate expression of the disease is expected if it presents in childhood.  There is a wide clinical...
 
Central Core Disease
Like many of the congenital myopathies, the features of central core disease tend to be more severe course if the disease initially presents in infancy.  A more moderate expression of the disease is expected if it presents in childhood, and the disease relatively...
 
Welcome to the Neuropathology course
Welcine to the neuropathology course!The pages, images, and multimedia files in this course should provide an ample introduction to neuropathology for a neurology resident. This course is designed to be adaptable to your style of learning, and how you approach the course is up to you...
 
Clinical Pathology Conference - November 6 2008 (video)

 
Shared Educational Resources
This section contains recorded lectures on neuropathology.  LEGAL STUFF: These presentations may contain information which is subject to copyright.  Downloading or copying any of these files is prohibited.  Although this material, or portions of this material...
 
Pilocytic Astrocytoma
Pilocytic astrocytomas are less common than diffuse astrocytomas, accounting for about 2% of all primary CNS tumors in all age groups.  However, they are the most common glioma in children.They frequently occur in the cerebellum, but can occur in other areas as well...
 
Meningiomas (video)

 
Ependymomas
Ependymomas are classified as glial tumors, although they also have epithelial properties.   They are common, accounting for 3%-9% of all brain tumors.  They can occur at any age, but are somewhat more common in children.40% of ependymomas occur in the first decade of life...
 
Gomori Trichrome
From an aesthetic point of view, the Gomori trichrome is my favorite muscle stain.  It also extremely helpful, and yields an abundance of the information.  A trichrome stain is a stain that highlights different chemical features in three different colors...
 
Gomori Trichrome, showing inclusion bodies (image)

 
CCD COX with arrow (image)

 
Perinatal Disorders of Gray Matter

 
Miscellaneous Demyelinating Diseases

 
Silver Stain
The silver stain is not used clinically as commonly as it used to be.However, if you see a silver stain on the Boards, think of Alzheimer's disease and amyloid plaques.  
 
Vascular Disease 1: Reaction to ischemic injury

 
Radiologic pathology

 
Vascular Disease 2: Vasculitides

 
Introduction to Neuropathology for Neurology Residents
Welcome to Introduction to Neuropathology for Neurology Residents.This course is designed to expose you to the basics of neuropathology.  We don't expect at the end of this course that you'll be able to diagnose neuropathologic zebras, or get a job as a neuropathologist...
 



Gallery Images



Normal skeletal muscle, H&E sta

 
Normal skeletal muscle, H&E stai

 
Wallenberg Syndrome MRI with arr

 
CCD COX with arrow

 
H&E Stain of an Anaplastic Astro

 
Note to gliageek 2

 
Note to gliageek 1