<prompt> A 70 year old male patient dies with severe dementia. Autopsy demonstrates marked atrophy of the frontal and temporal lobes, with relative sparing of the rest of the brain. Which of the following microscopic features would be most useful in establishing the diagnosis?Enlarged presynaptic axon terminals surrounding a central core of extracellular amyloid-like substanceIntracytoplasmic spherules composed of paired helical filamentsIntracytoplasmic spherules that stain brightly eosinophilicIntranuclear and intracytoplasmic inclusion bodies in enlarged cells  <response>: Selective frontal and temporal atrophy in a demented patient suggests Picks disease. Microscopically, severe neuronal loss and astrocytosis are seen. The characteristic microscopic finding in this disorder is the presence of Picks bodies, which are intracytoplasmic spherules composed of paired helical filaments, seen best with silver stains. 1st choice describes senile plaques. These are seen in Alzheimer disease as well as in some normal elderly individuals. 2nd choice describes Lewy bodies, seen in Parkinsons disease. 4th choice describes the inclusion bodies typically seen in glial cells and endothelial cells in cytomegalovirus encephalopathy. Ref: Ropper A.H., Samuels M.A. 2009. Chapter 39. Degenerative Diseases of the Nervous System. In A.H. Ropper, M.A. Samuels Eds, Adams and Victors Principles of Neurology, 9e. 