Department of Pathology, University of Oklahoma Health Sciences Center

NeuroTest Question #3 Next question Previous question

Answer: C (Hypoxic/ischemic changes) Level of difficulty: 3 NeuroTest NeuroLearn NeuroHelp

Discussion:

• Pathology: In this coronal section, several symmetrical changes are present. Part of the parietal cortex are reduced to a chalky line (Ú); this finding is know as laminar necrosis. This features could be easily recognized when it is compared to the temporal cortex that is of normal thickness (Ú). There are also symmetrical necroses involving the basal ganglia (Ú). Focal discoloration is present in the thalamus (Ú). The pathologic changes are therefore symmetrical. widespread and associated with necrosis. The most possible scenario would be a generalized hypoxic/ischemic insults such as those produced by hypotension. In addition, the patients must have survived after the episode for some time in order for the lesions evolve to the morphology being illustrated here.
• Neoplastic changes: First, there is no identifiable mass lesion here. Assuming that there is a diffusely infiltrating process is present, there is no distortion of the structure. This made this diagnosis highly improbable if not impossible.
• Viral encephalitis are associated with inflammation. In most cases they have widespread congestion and petechial hemorrhage. Some viruses, such as herpes simplex virus, also produce localized necrosis. All these features, however, are not present in this picture.
• Leukodystrophies are associated with greyish discoloration and degeneration of the white matter, a feature which is absent in this case. The arguable exception is metachromatic leukodystrophy which is characterized by chalky-white white matter with enhancement of the gray-white junction. Honestly, it is not fair to ask you to judge if there is any chalk-white discoloration based on this picture. However, there is no enhancement of gray-white junction. In addition, the laminar necrosis is typical for a hypoxic/ischemic injury. 

Comment: KarMing-Fung@ouhsc.edu