DIMITRI P. AGAMANOLIS, M. D. Akron Childrens Hospital NorthEastern Ohio Universities College of Medicine Neuropathology
TEST-CHAPTER TWO
CEREBRAL ISCHEMIA AND STROKE
Questions marked with * are more appropriate for residents.
1. If circulation ceases, the energy supplies stored in brain cells are enough to last:
a. 1-2 minutes
b. 3-5 minutes
c. 6-8 minutes
d. 10 minutes
2. The most common cause of HIE in a 60 year old patient is:
a. Respiratory arrest
b. Cardiac arrest
c. Hypoglycemia
d. Seizures
3. Neurons damaged by hypoxia or trauma discharge:
a. NO
b. Free radicals
c. Glutamate
d. GABA
4. Free radicals are generated in the:
a. Lysosomes
b. Cytosol
c. Mitochondria
d. Golgi apparatus
5. Cerebral edema in HIE is caused by:
a. Arachidonic acid.
b. Lactic acid.
c. Both.
d. Neither
6. Which of the following is most vulnerable in HIE?
a. The thalamus
b. The caudate nucleus
c. The substantia nigra
d. The inferior olive
7. The respirator brain is caused by:
a. A direct action of the respirator
b. Hypoxia
c. Autolysis
d. Inflammation
8. Most deaths following MCA occlusion in older patients occur:
a. During the 1st day
b. During the 3rd to 4th days
c. Between the end of the 1st week and 10 days
d. Mortality is the same in all periods
9. Restoring circulation to the ischemic penumbra can limit brain damage in an ischemic infarct. The window of opportunity for rescuing the penumbra is:
a. 1 to 2 hours
b. 3 to 4 hours
c. 5 to 6 hours
d. 12 hours
*10. Most fusiform aneurysms of the basilar artery cause:
a. Thrombosis with ischemic infarction of the pons
b. Rupture with subarachnoid hemorrhage
c. Both
d. Neither. They are usually asymptomatic
11. Amnesia involving recent and old memory may result from bilateral lesions of:
a. The hippocampus and amygdala
b. The thalamus
c. Both
d. Neither
12. The intracellular process that triggers cell injury in HIE is:
a. Release of lysosomal enzymes into the cytosol
b. Intracellular edema
c. Increased intracellular potassium
d. Increased intracellular calcium.
13. The persistent vegetative state may result from extensive damage of:
a. The hippocampus and amygdala
b. The cerebral cortex and thalamus
c. The nucleus basalis
d. The reticular activating substance of the brainstem
14. Intracranial arterial aneurysms can cause all of the following except:
a. Mass-like lesions
b. Pontine hemorrhage
c. Hydrocepalus
d. Cranial nerve deficits
*15. The pathological process illustrated below is associated with all of the following except:
Cerebral amyloid angiopathy
a. Peripheral neuropathy
b. Fatal intracerebral hemorrhage
c. Subcortical demyelination
d. Lacunar infarcts in the basal ganglia
*16. Risk factors for cerebral arterial occlusion and ischemic infarction iclude:
a. Elevated homocysteine
b. Factor V Leiden
c. Both
d. Neither
17. The lesion illustrated below can cause:
Arteriovenous malformation
a. Recurrent headaches
b. Homonymous hemianopsia
c. Focal seizures
d. All of the above
*18. The lesion illustrated in the slide below may be caused by occlusion of:
Wallenberg syndrome
a. Basilar artery
b. Vertebral artery
c. Both
d. Neither
19. The lesion illustrated below is due primarily to vascular occlusion
Cerebral infarct
a. True
b. False
20. The lesion illustrated below can cause severe neurologic deficits but is no threat to life
Lacunar infarct
a. True
b. False
21-24. Match the numbered pathological pictures, 21, 22, 23, and 24, with the lettered clinical deficits
PCA infarct ACA infarct
Hippocampal sclerosis MCA infarct
21a, 21b, 21c, 21d
22a
, 22b, 22c, 22d
23a
, 23b, 23c, 23d
24a
, 24b, 24c, 24d
a. Hemiparesis involving more severely the leg.
b. Visual deficit (cortical blindness).
c. Hemiparesis involving the face and arm.
d. Memory deficit
25-28. Match the numbered pathological pictures, 25, 26, 27, and 28, with the lettered arteries
PCA infarct ACA infarct
MCA infarct lateral medullary infarct
25a, 25b, 25c, 25d
26a
, 26b, 26c, 26d
27a, 27b, 27c, 27d
28a
, 28b, 28c, 28d
a. ACA
b. MCA
c. PCA
d. PICA, basilar, or vertebral artery

*29. The lesion illustrated below is caused by:
Ruptured Aneurysm
a. Gunshot wound
b. Contrecoup contusion
c. A ruptured AVM
d. Ruptured intracranial aneurysm
30. A 72 year old woman with a one year history of declining memory developed sudden headache and decreased consciousness and collapsed while washing dishes. Neuropathological examination revealed the lesion illustrated below. The most likely cause is:
Lobar hemorrhage
a. Hypertension
b. Cerebral amyloid angiopathy
c. Ruptured AVM
d. Trauma (the lesion developed when she fell)

*31. 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:
venous infarct Venous infarct
a. Lupus vasculitis
b. Embolism from non-bacterial endocarditis
c. Bilateral border zone ischemia
d. Superior sagittal sinus occlusion due to antiphospholipid syndrome
32. The MRI images shown below were obtained one month apart (the left first). The illustrated pathology can cause:
Hippocampal sclerosis
a. Seizures
b. Loss of the ability to learn new things
c. Both
d. Neither.
*33. A 60 year old previously healthy patient developed hemiparesis and aphasia. MRI showed an enhancing left hemispheric lesion. A brain biopsy was done (shown below)
Gemistocytic astrocytes
The pathology is most compatible with:
a. Changes around the wall of an abscess
b. A gemistocytic astrocytoma
c. An two month old ischemic infarct
d. An old MS plaque