A K Mahapatra

All India Institute of Medical Sciences, New Dilli, NCT, India

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Publications (290)301.95 Total impact

  • 01/2015; DOI:10.4103/1793-5482.150002
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    ABSTRACT: Traumatic bilateral basal ganglia bleed is extremely rare. It is defined as a hemorrhagic lesion located in the basal ganglia or neighboring structures such as the internal capsule and the thalamus. This report describes a 37-year-old man who had large bilateral basal ganglia hemorrhage (BGH) with subdural hematoma and traumatic subarachnoid hemorrhage. With regards to an etiology of bilateral hemorrhage of the basal ganglia, we could not disclose any possible cause except head injury in spite of full diagnostic work-up. Our final diagnosis was bilateral traumatic BGH (TBGH). The pathomechanism of such injuries is still not clear and it is proposed to be due to shear injury to the lenticulostriate and choroidal arteries. Rather than any features of the TBGH itself, duration of coma and/or associated temporal herniation predicted slower recovery and worse outcome. Bilateral TBGH is an extremely rare entity, compatible with a favorable recovery, if not associated with damage to other cortical and subcortical structures and occurring in isolation. TBGH can be considered as a marker of poor outcome rather than its cause. The BGHs seem to be hemorrhagic contusions resulting from a shearing injury, due to high velocity impact.
  • H D Nath, A K Mahapatra, S A Borkar
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    ABSTRACT: In giant encephalocele, head size is smaller than the encelphalocele. Occipital encephalocele is the commonest of all encephalocele. In our case, there was rare association with giant encephalocele with old hemorrhage in the sac. This was a unique presentation. In world literature, there was rare association with giant encephalocele with hemorrhage.
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    ABSTRACT: To evaluate clinical presentation and microsurgical outcome of giant pituitary adenomas (GPAs) in pediatric age. All patients <18 years, who were operated on at our center for GPA (tumor >40 mm in maximum diameter) were included in study. Clinical features, hormonal profile, radiology, surgical approach, results and complications were analysed. A total of 12 children with GPA were managed microsurgically. Visual deterioration (73 %) was most common presentation. Functioning adenomas were found in 83 % patients, with prolactinomas being most common. Twelve patients underwent a total of 16 microsurgical procedures, with a single surgery done in eight (75 %) patients. Out of the 12 primary surgeries, eight (67 %) were performed trans-sphenoidally. A near-total excision (>90 % tumor removal) could be achieved in six (50 %) patients. Visual improvement was observed in 44 % patients. However, there was no improvement in those where the eye was negative to perception of light prior to surgery. At the last follow-up, all the patients with functioning adenomas were in hormonal remission, and there was no residual/recurrent tumor in patients with non-functional adenomas. 25 % experienced single or multiple perioperative or postoperative complications. There was one perioperative death (8 %). GPAs are very rare in the pediatric population, with majority being functional and more aggressive in nature as compared to in adults. However, most of them can be approached trans-sphenoidally. The combination of surgery and radiotherapy, as well as medical therapy with bromocriptine, achieves good tumor control, despite a high rate of residual tumor and tumor recurrence.
    Child s Nervous System 04/2014; DOI:10.1007/s00381-014-2421-8 · 1.16 Impact Factor
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    ABSTRACT: Aim: The aim was to calculate, in monetary terms, total cost incurred by a Level I trauma center in providing in-patient care to brachial plexus injury patients during their preoperative and the postoperative stay. Subjects and Methods: All patients of brachial plexus injury admitted and discharged between January and December 2010 were included in the study. Total cost per bed was calculated under several cost heads in pre- and post-operative ward care. Intra-operative costs were excluded. Results: A total of 69 patients were admitted in the year 2010. Of these 60 were operated and the rest were planned conservative management. The total cost incurred by the trauma center in providing in-patient care to patients admitted in the ward, excluding high dependency unit, came out to be Rs. 3,650.00/patient/bed/day. Of this Rs. 2,234.645, the maximum amount was incurred in providing manpower alone. The average preoperative wait was 12 days (maximum 41 days and minimum 1-day). The average postoperative stay was 2 days. Total cost incurred in the preoperative period was Rs. 2,975,125 (US$ 59392) or Rs. 43,117/patient (US$ 861). It was Rs. 386,948 (US$ 7724) in the postoperative period (Rs. 6,449 or US$ 129/patient). Nine patients were not operated and had waited from 2 to 12 days before finally being planned for observant treatment. This itself cost the hospital Rs. 226,328 (US$ 4518). Conclusion: By just reducing the preoperative length of stay to 1-day the cost can be brought down by 93% for brachial plexus injury patients alone and the beds can be used to admit more critical patients.
    04/2014; 9(2):89-92. DOI:10.4103/1793-5482.136721
  • Neurology India 09/2013; 61(5):541-543. DOI:10.4103/0028-3886.121946 · 1.08 Impact Factor
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    ABSTRACT: Aim: Compound elevated fracture of the skull is an unusual variety of fracture of the cranial vault that has been rarely described in the currently available literature. The authors describe three such patients with post-traumatic compound elevated skull fracture. The pertinent literature is reviewed, the injury mechanism is highlighted and the management issues are discussed in detail. Case Description: All three patients in this series presented with elevation of free skull fracture fragments above the surface. The mode of injury was rail accident in two patients and injury by a rapidly moving crane in one patient. Two patients had dural laceration with extrusion of brain matter through the dural defect. The remaining patient had an elevated fracture fragment simulating a formal craniotomy with an intact dura. The patient who suffered crane injury was brought dead. Surgery was performed in remaining two patients. Wound debridement and duraplasty was performed. Both patients received broad-spectrum antibiotics in anti-meningitic doses. Both of these patients did well after surgery. Conclusion: Elevated skull fractures are usually compound injuries. High velocity tangential impact to the skull vault is the most likely causative mechanism in such type of injury. Delay in surgery could lead to intracranial sepsis including meningitis and brain abscess. Thus, these fractures should be aggressively treated.
    Turkish neurosurgery 07/2013; 23(4):514-517. DOI:10.5137/1019-5149.JTN.3694-10.2 · 0.53 Impact Factor
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    ABSTRACT: Background: Spinal dural arteriovenous fistula (SDAVF) is a common type of spinal vascular lesion. However, there has not been any published study on its clinico-radiological characteristics or surgical outcome from India. Aim: The aim of this study was to determine the clinico-radiological features of patients with SDAVF, outcomes following surgical ligation of the fistula and the various factors involved. Materials and Methods: Patients who were operated for SDAVF were studied for demographic details, symptoms, clinical severity, radiological features and neurological outcome in the form of improvement in gait disability grades. Appropriate statistical tests were performed. Results: There were 22 (19 males, 3 females) patients of SDAVF who underwent surgical ligation with a mean age of 55 years. The mean duration of symptoms at presentation was 15 months. Three patients had acute onset while the rest had insidious onset of symptoms. Out of the 22 patients, 11 (50%) had motor weakness as the first symptom, 13 (59%) were bedridden and 19 (86.4%) had bladder involvement at presentation. Thirteen patients had fistulae in thoracic spine, whereas eight had fistulae in the lumbar spine. All had a favorable outcome in the form of at least non-progression of gait disability (14 had improvement while 8 had stabilized). The improvement was non-significantly associated with younger age, acute onset, ambulant status and fistula below T9. It was inversely associated with pain as the first symptom and fluctuant clinical course. Conclusion: Surgical occlusion of SDAVF is usually associated with either improvement or stabilization of motor weakness.
    Neurology India 07/2013; 61(4):406-10. DOI:10.4103/0028-3886.117616 · 1.08 Impact Factor
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    ABSTRACT: Primary tethered cord syndrome refers to a group of neural tube defects that are not externally obvious, and, if detected at an early age, surgical intervention may prevent the significant irreversible neurological deficits. This study was performed to evaluate the presenting clinical features of patients with primary tethered cord syndrome and the indications of surgery in such patients as well as the clinical and urological outcome. In all cases, the indication for surgery was the presence of a tethered cord on magnetic resonance imaging, the criteria for tethering being a low-lying conus (below L1-L2) and a thickened filum (>2 mm). Urodynamic studies were performed before detethering. Microsurgical detethering of low-lying cord was then performed, and the patients were then followed clinically and urologically for 6 months. Pain responded the most to detethering while limb weakness and urological symptoms responded the least. Clinical improvement in urological symptoms correlated with improvement in urodynamic parameters. A urodynamic study identified improvement in a larger number of patients and also deterioration in a few patients which was not visible clinically; this may point to its high sensitivity and usefulness in preceding clinical manifestations in a future follow-up.
    Pediatric Neurosurgery 05/2013; 48(4):210-215. DOI:10.1159/000345829 · 0.50 Impact Factor
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    ABSTRACT: An 11-year-old boy presented with gradual cognitive decline, gait disturbances, decrease in vision and intermittent headache for 2 months. Examination revealed papilledema, altered sensorium, Parinaud syndrome and spasticity. Magnetic resonance imaging of the brain is shown in figure 1 . What is the probable diagnosis?
    European Neurology 05/2013; 70(1):33-34. DOI:10.1159/000347221 · 1.36 Impact Factor
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    ABSTRACT: Background. Vasospasm plays a major role in the morbidity and mortality after aneurysmal subarachnoid hemorrhage (aSAH). The preliminary studies suggest that statins protect against cerebral vasospasm. Objective. The aim of the study was to determine the role of simvastatin in preventing clinical vasospasm and improving functional outcome in patients with aSAH. Methods. All patients with aSAH admitted within 96 h of ictus were randomized to receive either Simvastatin or placebo - 80 mg/day for 14 days. Thirty eight patients were recruited in the study- 19 received Simvastatin and 19 placebo. All the patients underwent surgical clipping of the aneurysm. The primary outcome of the study was the development of clinical cerebral vasospasm. The secondary outcomes included Glasgow Outcome Score (GOS), Modified Rankin Scale (MRS) and Barthel Index Score (MBI) at follow-up at 1, 3 and 6 months. Results. 16% of the patients in the simvastatin group had high Middle Cerebral Artery velocities (> 160 cm/sec) on transcranial Doppler on one or more than one day during the study duration as compared to 26% of the patients in the placebo group (p = 0.70). Neurological deterioration occurred in 26% and 42% of the patients in simvastatin group versus placebo group, respectively (p = 0.31). There was an improvement in the functional outcome in the simvastatin group at 1, 3 or 6 months in the follow-up; however, this difference was not statistically significant. Conclusions. There was benefit of simvastatin in terms of reduction in clinical vasospasm, mortality or improved functional outcome, however, this was not statistically significant.
    British Journal of Neurosurgery 01/2013; 27(2). DOI:10.3109/02688697.2012.757293 · 0.95 Impact Factor
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    ABSTRACT: INTRODUCTION: Significant controversy exists regarding reversal of antiplatelet agents in traumatic brain injury (TBI). The purpose of this study was to evaluate the impact reversal of antiplatelet agents through platelet transfusion has on radiographic progression of intracranial injury. METHODS: We conducted a retrospective comparative cohort study reviewing all cases of TBI with positive radiographic findings treated at our institution between 2006 and 2010. We assessed baseline demographics, coagulation parameters, transfusion management, and clinical course. The primary endpoint was radiographic progression of intracranial injury defined as increased hemorrhage volume (ABC/2 method or slice distribution in SAH) within 12 hours of initial injury. RESULTS: A total of 790 patients suffering mild (85%) to moderate and severe TBI (15% combined) with radiographic intracranial injury and antiplatelet use were assessed. Of these, 65 % were taking aspirin, 11% clopidogrel, and 23% both. On presentation, 65% of patients received platelet transfusion for reversal. Progression of intracranial pathology occurred in 27% of patients. Progression was not significantly different with respect to platelet transfusion status; 30% of those transfused vs 23% of those not transfused had worsened hemorrhage on repeat scans. These findings remained stable after adjusting for age, type of pre-morbid antiplatelet agent, time-to-transfusion, and radiographic injury severity. CONCLUSION: Reversal of oral antiplatelet therapy was not associated with decreased progression of intracranial injury. This data calls into question the reflexive transfusion of patients on antiplatelet therapy in favor of more judicial approaches. Copyright (C) by the Congress of Neurological Surgeons
    Neurosurgery 01/2013; 60:175. DOI:10.1227/01.neu.0000432756.38655.f1 · 3.03 Impact Factor
  • Turkish neurosurgery 01/2013; DOI:10.5137/1019-5149.JTN.7017-12.1 · 0.53 Impact Factor
  • S. A. Borker, Guru Satyarthee, A. K. Mahapatra
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    ABSTRACT: No abstract available.
    Pediatric Neurosurgery 11/2012; 48(2). DOI:10.1159/000343483 · 0.50 Impact Factor
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    ABSTRACT: Split cord malformations (SCM) with a dorsally located bony spur are a very rare entity. The authors report a series of four such cases. The literature is reviewed regarding the pathogenesis and management of this uncommon variant of SCM. The presenting features include - scoliosis with motor and autonomic dysfunction (n = 1), scoliosis with cutaneous patch (n = 1), hypertrichotic area (n = 1), and motor deficits alone (n = 1). The location of spur was thoracic and lumbar in two patients (50%) each. Low-lying conus was present in three patients. Long segment syrinx was present in one patient. With respect to the bony anomalies, two patients had a hypertrophied posterior arch (HPA) and one patient had a dysraphic spine. All patients underwent surgical excision of the spur with detethering, if a low-lying conus was present. Two patients developed transient worsening of the neurological status after surgery which recovered at the time of the last follow-up; in both these patients, there was a HPA and a low-lying conus. Surgical excision of the spur with detethering of filum, in cases of low-lying conus, is the treatment of choice. Risk of post-operative worsening of the neurological status is increased in cases in which there is concomitant presence of HPA.
    Journal of Pediatric Neurosciences 09/2012; 7(3):167-70. DOI:10.4103/1817-1745.106469
  • S P Joshua, Pankaj Kumar Singh, A K Mahapatra
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    ABSTRACT: Lipomeningocele is a type of occult spinal dysraphism characterized by a subcutaneous lipomatous mass that protrudes through a midline bony defect. We report a rare presentation of this condition - a vertebral choristoma wherein the lipomatous mass displaced the normally formed posterior elements - lamina and spinous process of L4 vertebra dorsally to an abnormal location in the absence of a bony defect.
    Pediatric Neurosurgery 07/2012; 48(1):59-61. DOI:10.1159/000339314 · 0.50 Impact Factor
  • A K Mahapatra
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    ABSTRACT: BACKGROUND: Giant encephalocele is a rare condition and few published reports are available in the English literature. It is a challenge to neurosurgeons, even today. This series consists of 14 patients with giant encephaloceles treated at our institute. MATERIAL AND OBSERVATION: Over a period of 8 years, from 2002 to 2009, 110 patients with encephaloceles were managed at our institute. Amongst them, 14 were children with giant encephaloceles. All patients had CT/MRI or both prior to surgery, and all were operated upon. Four patients were neonates, under 1 month of age, and 9/14 patients (64%) were under 3 months. The youngest child was a newborn baby aged 2 days. Except for 1 with an anterior encephalocele, the rest were patients with occipital encephaloceles. A CT scan was performed on 5 and an MRI on 1 patient. Both CT and MRI scans were performed on the other 8 patients. MRI/CT showed hydrocephalus in 10/14 patients. Of these, 7 required ventriculoperitoneal (VP) shunt, and the remaining 3 with mild to moderate hydrocephalus did not. Of the 7 patients who underwent VP shunt, 5 had a shunt during the encephalocele repair and 2 had a postoperative shunt for increasing hydrocephalus. RESULTS: Other associated anomalies recorded were acquired Chiari malformation in 3 patients, secondary craniostenosis with microcephaly in 5, and syringomyelia in 1 patient. All the patients underwent repair of encephalocele and 4 had suturectomy of coronal suture for the secondary craniostenosis. There were 2 postoperative deaths due to hypothermia. Among the 12 surviving patients, 9 had a good outcome and 3 had poor mental development. The present study shows overall good outcomes in 9/14 (66%) patients.
    Pediatric Neurosurgery 07/2012; 47(6):406-11. DOI:10.1159/000338895 · 0.50 Impact Factor
  • Clinical neuropathology 07/2012; vol. 31(4.2012-vol. 31-No. 4/2012):232-290. · 1.31 Impact Factor
  • Vivek Tandon, Kanwaljeet Garg, A K Mahapatra
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    ABSTRACT: Serous adenocarcinoma of the ovary rarely can present with solitary solid -cystic cerebellar metastasis, mimicking pilocytic astrocytoma. A middle aged women, who underwent total abdominal hysterectomy with bilateral salpingoopherectomy and adjuvant chemotherapy for ovarian adenocarcinoma, presented to us with the history of headache, vomiting, and imbalance. Contrast enhanced magnetic resonance imaging (MRI) showed solitary cerebellar, solid cystic lesion with cyst lining and solid portion enhancing on contrast which was mimicking pilocytic astrocytoma and there was no perilesional edema. Gross total excision of the cerebellar lesion was done followed by resolution of her symptoms. Histopathology showed metastatic adenocarcinoma consistent with the primary ovarian carcinoma. In patients of ovarian carcinoma, presenting with features of raised intracranial pressureICP] thorough investigations must be done to rule out metastasis. Solitary metastasis of the cerebellum because of ovarian carcinoma may mimic pilocytic astrocytoma.
    07/2012; 7(3):141-3. DOI:10.4103/1793-5482.103720

Publication Stats

2k Citations
301.95 Total Impact Points

Institutions

  • 1985–2014
    • All India Institute of Medical Sciences
      • • Department of Neurosurgery
      • • Department of Microbiology
      • • Department of Medical Oncology
      New Dilli, NCT, India
  • 2007–2009
    • Sanjay Gandhi Post Graduate Institute of Medical Sciences
      • Department of Neurosurgery
      Lucknow, Uttar Pradesh, India
  • 2003–2004
    • Philadelphia ZOO
      Philadelphia, Pennsylvania, United States
  • 2000–2003
    • Khoula Hospital
      Masqaţ, Masqaţ, Oman
  • 2001
    • The Royal Hospital
      Masqaţ, Muḩāfaz̧at Masqaţ, Oman
  • 1995
    • AIIMS Bhopal All India Institute of Medical Sciences
      Bhopal, Madhya Pradesh, India