Question #158 (10/2/2026) Survey

Submitted by Dr. Ilaria Tarozzi (PGY-2 Resident Anatomic and Clinical Pathology) and Dr. Michael Punsoni (Neuropathologist, Director of Autopsy Service, Director of Ophthalmic Pathology), Brown University, Providence, Rhode Island.

1.An 80-year-old female with a past medical history of hypertension, hyperlipidemia, peripheral neuropathy, and depression underwent a brain-only hospital autopsy upon family request. The fresh brain weight was 1,026 grams. Gross examination showed diffuse atrophy, moderate ventricular dilatation, severe non- occlusive atherosclerosis, and moderate arteriolosclerosis. Histologic and immunohistochemical findings are shown in the accompanying images.

Which premortem history would most strongly support the neuropathologic findings demonstrated in the pictures?

A. Progressive personality change with disinhibition, compulsive behaviors, and loss of empathy

B. Recurrent episodes of confusion, somnolence, and flapping tremor accompanied by elevated serum ammonia

C. Repetitive episodes of head trauma over many years of domestic violence

D. Several years of progressive memory impairment, increasing dependence on family for self-care, and recurrent visual hallucinations

Question #158 (10/2/2026)

National Association of Medical Examiners Educational Activities Committee

National Association of Medical Examiners
Educational Activities Committee