 Welcome back to our MedSmarter question of the week, where we're taking a smarter approach to preparing future physicians. Before we get started, if you'll take just a quick minute and click that like button, and also subscribe and turn the bell on so that you'll be notified when we post new videos. Let's get right to that question. As always, we start with the last sentence of the vignette before we go back and read the rest. From which disease did the decedent most likely suffer? After a 65-year-old man with a progressive chronic movement disorder dies, the family requests an autopsy. On gross inspection of the patient's brain, the pathologist notes the presence of a deep brain stimulator electrode. The pathologist then obtains a tissue specimen of the basal ganglia for histological analysis, look at the image which we'll see in just a minute, that stains positive for alpha synnuclein. From which disease did the decedent most likely suffer? So let's take a look at this picture here. So if you can tell what you're looking at here in the middle, this is going to be an inclusion body, which is just an aggregation of protein. So that should give us a good information if you can remember back to your basic pathology in this question. So let's go ahead and look at the answer choices. So look at these answer choices. Take a minute, go back and read the question, come up with an answer and write it in the comment box below. Alright, so here's a couple things that we need to note before we start eliminating. So we're talking about a 65-year-old man and he had progressive chronic movement disorder. That's a very big key in this question. He dies, he did have a deep brain stimulator. That's going to be something that will probably be important. And we see alpha synuclein in a basal ganglia histological slide. Those are the main things from this, the rest is just kind of filler. Alright, so let's look at these question answer choices. A, Huntington's disease. Alright, if you remember with Huntington's disease, they do have those career form movements. So that would kind of fit a little bit in the movement disorder. However, what we're seeing in the picture here is what is known as a Lewy body. And if you can remember that from your pathology, that that's a Lewy body that can help you eliminate some of these answer choices. Huntington's disease is a autosomal dominant disease where the caudate nucleus actually kind of atrophies. And so that is not something that we have Lewy bodies in. So that would remove Huntington's disease as an option choice for me. B, Guillain-Barre syndrome. If you remember anything about Guillain-Barre, this is a demyelinating disorder. Does not have Lewy body issues. It can have movement problems, but it's more due to the demyelination and not due to any Lewy bodies present. So that would rule out B. C, Picks disease. Picks disease, this is a neurodegenerative disease. We can see that movement issues kind of like Parkinsonism. So I'm going to leave this one in for right now because it does kind of fit a little bit of my possibilities. But I'm not 100% sure that this could be our answer choice. D, Werdnig-Hoffman disease. This is spinal muscle atrophy here. It's autosomal recessive. We're not talking about anything associated with that. So D is already going to be taken off of my answer choice list already. So E, Parkinson's disease. So I mentioned Parkinsonism type disease with Picks disease, but now we have just pure Parkinson's disease as an option choice. If you can remember back to Parkinson's disease, it does have Lewy bodies, which is what I believe the picture is showing us here. Those are just cytoplasmic inclusions. And because it is alpha-synuclein positive, that does also follow into the Lewy body Parkinson's side of things. And going back to Picks disease, I'm fairly certain that I remember that Picks disease does not have any Lewy bodies even though it has that Parkinsonism. So you need to be able to make sure you're able to distinguish between those two. Therefore, knowing all that, E would be my final answer. And E is the correct answer. So like I said, we are looking at in this picture a view of a Lewy body, which are cytoplasmic inclusions. And these actually have alpha-synuclein, tubulin, ubiquitin, and neurofilament proteins all a part of these inclusion bodies. Basically, this is probably coming from proteosomal activity that is being disrupted. And then all of these cellular proteins from inside the cell are aggregating and accumulating, which is going to disrupt our normal processes of the cell. And these are often found in the substantia nigra as far as Parkinson's goes. And that's why we have the movement disorder because the substantia nigra is going to be mostly associated with movement issues. Just a side note here, this patient had a deep brain stimulator electrode and that can be traced back to movement disorder issues and trying to kind of decrease those movements. So that would be why he had a deep brain stimulator electrode due to the Parkinson's disease. If you found this material helpful for your studying, please like and consider subscribing to the channel. Also, share this video so that more people can benefit from it like you have.