NVS PATHOLOGY WEEK 1 (by anis)

A) SRA
1. A 32-year old woman with a pituitary tumour presents with visual problems. Physical
examination reveals a loss of lateral halves of the field of vision of both eyes. Which of the
following structures was most likely compressed by the tumour?
A. Optic chiasma
B. Optic nerve
C. Optic tract
D. Oculomotor nerve

Answer: A

First, we need to understand visual pathway. Each left and right eye has both nasal field and temporal
field. temporal field is at the lateral part whereas nasal is at medial part.

For red-colored nerve:

It picks up visual information from left nasal field, and synapse at left lateral geniculate body, to the
oculomotor nerve, along the optic tract. No crossing of optic chiasma happens here because nasal field
and geniculate body both are from left side.

Also, red-colored nerve picks up information from right temporal field, and synapse at left lateral
geniculate body along optic tract. This time, there is crossing of optic chiasma as from different side.

For blue-colored nerve:

It picks up visual information from left temporal field, crossing the optic chiasma, in order to synapse at
right lateral geniculate body. As for visual information carried from right nasal field to right lateral
geniculate body, there is no crossing of optic chiasma.
 Location of lesion What happens
Left optic nerve (A) Nerve carrying info from left
temporal field and left nasal field
are affected
Optic chiasma (B) Nerve carrying info from right
temporal field and left temporal
field are affected
Left optic nerve, after Nerve carrying info from left
crossing optic chiasma temporal field and right nasal
(C) field is affected
Left optic tract (D)
Vision problems
Left anopia
Bitemporal hemianopia
(Bi= both left and right, hemi= half
only which is temporal)
Right homonymous hemianopia
Right homonymous superior
quadrantanopia

2. Lesion to the basal ganglia results in

A. bradykinesia
B. intention tremor
C. sensory loss
D. nystagmus

Answer: A

Basal ganglia is responsible for Parkinson’s disease, symptoms including bradykinesia, dystonia, and
resting tremor. Other options other than A represent symptoms when there is a cerebellar disease. Easy
way to remember cerebellar disease is by pneumonic DANISH
3.During a soccer game, the football hit a 24-year-old player in the temporal region which resulted in
rupture of the middle meningeal artery. This will result in a

A. subdural hematoma
B. subarachnoid hematoma
C. epidural hematoma
D. intracerebral hematoma

Answer: C

Epidural hemorrhage is a condition when blood accumulate between skull and dura, as dura is peeled
out from skull. The blood accumulated is arterial blood. Common causes are rupture of middle
meningeal artery and skull fracture.

Subdural hemorrhage is a condition when blood accumulate in dura space, where the dura is still intact
with the skull. The blood accumulated is venous blood. Common causes are rupture of bridging veins,
lumbar puncture and hydrocephalus. Patient commonly come with lucid interval, whereas they become
unconscious, then temporary improvement, then suddenly having neurological symptoms.

Subarachnoid hemorrhage is when blood accumulate in subarachnoid space, common causes are
rupture of berry aneurysm,

Lastly is intracerebral hemorrhage, when blood accumulate in brain parenchyma. Common causes are
atherosclerosis, microaneurysm, and amyloidosis
 B) CBQ

A 25-year-old man had an accident and unable to move all his four limbs, and felt no sensation of pain
below neck region. Neurological examination revealed flaccid paralysis. CT scan showed multiple
fracture of cervical spine at C6-C7 level.

a) Based on symptoms, the patient is having a lower motor neuron lesion. Briefly describe it.

A lower motor neuron lesion refers to damage or dysfunction of the motor neurons in the peripheral
nervous system, specifically the lower motor neurons that originate in the spinal cord and cranial
nerves. These lesions can occur due to various causes, including trauma, infection, inflammation,
tumors, or degenerative disorders.

A lower motor neuron lesion typically leads to weakness, muscle atrophy, diminished reflexes, flaccidity,
fasciculations, and specific deficits in the region supplied by the affected motor neurons. For example, if
the lesion affects the facial nerve, it may result in facial weakness or paralysis on the affected side.
 C) OSPE

A 43- year old female complained of headache and two attacks of seizures in the past 4 months . Brain
MRI revealed a 3 cm extra-axial mass in the parietal region. It was dural- based with mild edema in the
surrounding brain tissue.

a) Describe the gross features in above diagram

 Well defined mass attached to the base of Dura and compress brain parenchyma.

b) Describe microscopic features in above diagram

 Whorls Pattern of fibrocellular tissue.
 Cells are oval, spindle shape or elongated and lack mitosis.
 Psammoma bodies(spherical calcified particles)

c) What is the diagnosis?

 Meningioma