S Das

Dharwad Institute of Mental Health and Neurosciences, Hubli, Karnātaka, India

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Publications (33)72.91 Total impact

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    ABSTRACT: Primary angiitis of CNS(PACNS) or granulomatous angiitis of CNS is a rare inflammatory disease of small blood vessels mostly confined to the CNS. The clinical and pathological features of 3 autopsied cases are described. Clinically all the three PACNS patients were young males, age ranging from 19 to 31 years. All presented with varied neurological manifestations. There was no evidence of systemic disease in any of the cases. The ESR was normal and CSF analysis showed chronic meningitic pattern. The cerebral angiogram in one case was normal and the CT scan done in another case showed multiple intracerebral haematoma due to vasculitis. Brain biopsy was not done. Diagnosis was made at post-mortem examination. Histology showed characteristic but variable degree of granulomatous and non-granulomatous angiitis of small vessels. Venulitis with parenchymal haemorrhages was the predominant feature and in one case phlebitis with thrombosis was noted. Since the disease responds to steroids and immunosuppressive therapy, establishing antemortem diagnosis is important. In view of the association of angiitis of CNS with bacteria and viral infections, their role in the evolution of the disease needs to be investigated.
    Neurology India 07/2000; 48(2):149-54. · 1.04 Impact Factor
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    ABSTRACT: A neuropathological report of Madras type of motor neuron disease (MMND) is presented and the differences from other forms of MND are discussed. An 18-year-old girl presented with nerve deafness and slowly progressive bulbo-spinal muscular atrophy, characteristic of MMND. Post-mortem examination of the spinal cord showed a severe loss of anterior horn cells, prominent dilatation of vessels, diffuse, but sparse sprinkling of microglial cells and lymphocytes, and demyelination and sclerosis of the ventrolateral columns. Neuronal depletion and marked gliosis was noted in the cochlear nucleus on both sides, while other bulbar motor nuclei were also involved. The cochlear nerve showed demyelination and axonal loss. Trigeminal and vestibular ganglia revealed features of ganglionitis. The possibility of an inflammatory aetiology for MMND needs to be considered.
    Acta Neuropathologica 05/2000; 99(4):428-34. · 9.73 Impact Factor
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    ABSTRACT: Centronuclear myopathy (CNM), an uncommon condition, is one of the congenital myopathies. It is believed to arise as a result of maturational arrest, with persistence of myotubes postnatally. However, denervation being the basic disease process and its possible influence on central nervous system causing defect in nuclear migration has also been postulated. Keeping in view these existing controversies, we have studied 17 cases of CNM (neonatal - 1, childhood - 13, adulthood - 3) during the last twelve and a half years. Diagnosis was based on histological and enzyme histochemical findings of muscle biopsy along with clinical data. Ultrastructural characterstics of muscle have been studied in 10 cases. The affected muscle fibres showed a central nucleus (40-99%) with perinuclear halo. Type I fibre predominance with hypoplasia was consistently seen. Fibre type disproportion was noticed in 7 cases. The neonatal form revealed dense oxidative enzyme reaction product in the centre. The morphological features of CNM were compared with foetal skeletal muscles obtained at gestational ages ranging from 9 weeks - 36 weeks (n = 18). In the severe neonatal form th myofibres resembled the foetal myotubes. In the less severe childhood and adult form of CNM, aberrant organization of cytoskeletal network might have played a pathogenetic role in causing the disease.
    Neurology India 04/2000; 48(1):19-28. · 1.04 Impact Factor
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    ABSTRACT: Clinical, histological, immunohistochemical and ultrastructural features of 5 cases of inclusion body myositis -4 sporadic (s-IBM) and one hereditary (h-IBM) form are described. These patients (3 men, 2 women) had chronic progressive weakness of varying severity in all 4 extremities with sparing of cranial muscles. Elevation of CPK was noted in 2 patients. Electromyography revealed features of myopathy in 4 and additional neurogenic changes in 2 subjects. Clinical diagnosis was often other than inclusion body myositis. Presence of characteristic eosinophilic inclusions within the vacuoles established the diagnosis. The inclusions were congophilic and showed positivity to ubiquitin, beta-amyloid and SMI-31 in the sporadic cases while congophila was absent in the hereditary form. Immunostaining to hyperphosphorylated-tau was negative in both s-IBM and h-IBM. Membraneous whorls were observed at ultrastructural level. None of the patients improved with steroids and trial with other immunosuppressants was unsuccessful.
    Clinical neuropathology 01/2000; 19(1):13-20. · 1.34 Impact Factor
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    ABSTRACT: A boy developed sudden severe generalized muscle stiffness, bulbar weakness and passed dark coloured urine. Laboratory tests revealed marked elevation of creatinine kinase(CK) levels and myoglobinuria. Histopathology of quadriceps muscle showed features of acute rhabdomyolysis. Patient made complete clinical recovery over a period of three weeks and CK returned to normal level. The possible aetiologies of non-traumatic rhabdomyolysis are discussed and the relevant literature reviewed.
    Neurology India 04/1999; 47(1):51-4. · 1.04 Impact Factor
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    ABSTRACT: Benign triton tumor (neuromuscular hamartoma) is a rare tumor of the peripheral nerves, comprising mature neural and striated muscle elements. We report the third case, according to the literature, of a benign triton tumor affecting the Vth cranial nerve in a 4-year-old male child. The tumor was seen to involve the mandibular division of the trigeminal nerve in the infratemporal fossa and extend intracranially by eroding the base of middle cranial fossa. The mass was totally excised. In the tumor, bundles of axons intermingling with fascicles of relatively mature skeletal muscle were found. This type of hamartomatous lesions of neuroectodermal-mesenchymal origin could have arisen as the result of incorporation of mesenchymal tissue into nerve sheaths during embryogenesis or aberrant differentiation of neuroectodermal component into mesenchymal elements.
    Child s Nervous System 04/1999; 15(2-3):140-4. · 1.24 Impact Factor
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    ABSTRACT: A boy developed sudden severe generalized muscle stiffness, bulbar weakness and passed dark coloured urine. Laboratory tests revealed marked elevation of creatinine kinase(CK) levels and myoglobinuria. Histopathology of quadriceps muscle showed features of acute rhabdomyolysis. Patient made complete clinical recovery over a period of three weeks and CK returned to normal level. The possible aetiologies of non-traumatic rhabdomyolysis are discussed and the relevant literature reviewed.
    Neurology India. 01/1999;
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    ABSTRACT: Thirteen cases of vacuolar myopathy (6 males, 7 females), with age range of 4 months to 22 years and diagnosed over a period from 1986 to 1999, could be categorized into acid maltase deficiency (AMD) (n=6), carnitine deficiency (CD) (n=5), and mitochondria-lipid-glycogen myopathy (MLGM) (n=2), cases of AMD presented as floppy infants with reparatory infection, while cases of carnitine deficiency presented with progressive motor weakness with normal initial milestones. Delayed motor milestones and proximal muscle weakness was the presenting complaints in MLGM. The diagnosis in all these cases was established based on the morphological findings on muscle biopsy, namely demonstration of PAS positive material within the vacuoles in AMD, ragged red fibers, vacuoles containing neutral fats and abnormal mitochondria in CD. MLGM was characterized by the presence of PAS positive material and neutral fat. The diagnosis was confirmed by identification of abnormal mitochondria under electron microscope. The storage product appears to affect not only the muscle metabolism but also the normal structure function relationship. The study highlights the importance of supplementing routine histopathology with muscle histochemistry and election microscopy to delineate the conditions, which look similar in routine histology.
    Annals of Indian Academy of Neurology. 01/1999;
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    ABSTRACT: An unusual case of cerebellar neurocytoma with rhabdomyomatous differentiation in a 6-year-old boy is reported. Immunocytochemical and ultrastructural features of the tumour were studied. Abortive synapse formation, the presence of clear vesicles and synaptophysin immunoreactivity of the tumour cells indicated its intermediate neuronal differentiation, while the presence of myoblasts and myotubes and immunolabelling by desmin confirmed the rhabdomyomatous differentiation. In addition, the mesenchymal cells variably expressed neurofilament protein and glial fibrillary acidic protein, suggesting inductive interaction between the neuroectodermal and ectomesenchymal elements and persistence of the pleuripotential nature of the cells along the rhombic area of the brain stem.
    Acta Neuropathologica 03/1998; 95(3):318-23. · 9.73 Impact Factor
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    ABSTRACT: The pathomorphological features noted in 47 cases of HIV/AIDS studied on autopsy (39 cases) and surgical biopsy material (8 cases) over a period of 8.5 years are described here. The serum samples of all cases and 26/29 CSF samples tested were positive for anti HIV antibodies. Majority of patients were young adult males in the age group 25-35 years. History of high risk behaviour was available in 59.6% cases. 38/39 autopsied cases succumbed to various opportunistic infections. Infection by a single pathogen was noted in 76.3% cases and due to multiple infectious agents in 23.7%. The commonest opportunistic infection was cryptococcosis (59%) followed by toxoplasma encephalities (28.2%) and tuberculous meningitis (25.6%). The others included meningococcal meningitis, herpes simplex, cytomegalovirus and acanthamoeba encephalitis noted in one case each. Features meningococcal meningitis, herpes simplex, cytomegalovirus and acanthamoeba encephalitis noted in one case each. Features of HIV leucoencephalitis was noted in one autopsy and tow brain biopsy specimens. Complete body necropsy carried out in 11/39 cases revealed disseminated cryptococcosis in 5, tuberculosis in 4 and features of HIV related changes of lymphoreticular organs in 3 cases. Pneumocystis carinil pneumonia was noted in 2 patients along with cryptococcosis. Diagnostic lymph node biopsy in 3 patients revealed tuberculous lymphadenitis in 2 and infection by non-tuberculous mycobacteria in one. Evidence of IIIV associated neuropathy was noted in 3 cases. In the present series, the incidence of cryptococcal meningitis was very high compared to neurotuberculosis as reported from other clinical and one autopsy series from other parts of India. Similarly, the incidence of toxoplasma encephalitis was also higher. The type of laboratory support and the experience of the pathologist play a crucial role in accurate identification of the pathogens. Therefore, a high index of clinical suspicion and a proper diagnostic approach to HIV/AIDS patients is required in developing countries to identify various pathological lesions.
    Annals of Indian Academy of Neurology. 01/1998;
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    ABSTRACT: Dysembryoplastic neuroepithelial tumor (DNT), a benign neoplasm, is now a well recognized clinicopathological entity. We report the second case of DNT in the cerebellum occurring in a 20-year-old male presenting with ataxia. He also had Arnold-Chiari malformation of the adult type. Histologically the tumor was a "simple" DNT having the specific "glioneuronal" element, namely oligodendrocyte-like cells (OLCs), mucoid change and floating neurons (Purkinje cells). A striking feature was the perpendicular arrangement of the neuropil columns extending from the pial surface to white matter similar to those seen in supratentorial examples. On immunstaining some of the OLCs were positive for synaptophysin and negative for glial fibrillary acidic protein (GFAP), glucocerebroside, tau and MAP-2. The neuropil was synaptophysin-positive and focally positive for MAP-2 and GFAP as well. The Purkinje cells were morphologically normal but malaligned and were positive for phosphorylated neurofilament suggesting secondary dysplastic changes. A transition of the lesion into relatively normal cerebellum preserving the folial architecture was observed. The histological and immunochemical features of the DNT in cerebellum suggests its possible origin from the pluripotential external granular layer.
    Clinical neuropathology 01/1998; 17(6):305-10. · 1.34 Impact Factor
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    ABSTRACT: Congenital muscular dystrophy (CMD) is a relatively uncommon disease with a controversial nosological status. That collagen synthesis could be the primary abnormality has been suggested earlier (Fidzianska et al., 1982). Amongst eighteen cases of CMD diagnosed during the past twelve years, muscle biopsy in three cases revealed prominence of myofibre necrosis and phagocytosis, and serum CPK was markedly elevated suggesting a rapidly progressive form. In twelve cases, marked increase in endomysial collagen, pronounced fallout of myofibres and significant fibre diameter variation was seen. This was associated with myonecrosis and regenerative activity of mild degree resembling the classical form of CMD. In the remaining three cases, polyfocal, polyphasic necrosis was noticed. Fibre splitting was more frequently observed, better delineated in the enzyme histochemical preparations, affecting both fibre types, while endomysial fibrofatty tissue was only moderately increased. The histomorphology in the latter group resembled that of limb girdle dystrophy. Ultrastructural findings in all the eighteen cases correlated well with light microscopic observations. lmmunohistochemical studies done on three of the eighteen cases showed normal localization of dystrophin protein. Such variable histomorphology, revealing a spectrum of myopathic features, suggests that the primary change in CMD is likely to be in the myofibre rather than in collagen synthesis.
    Journal of the Neurological Sciences 09/1997; 149(2):157-63. · 2.24 Impact Factor
  • Alzheimer Disease and Associated Disorders 07/1997; 11(2):107-9. · 2.73 Impact Factor
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    ABSTRACT: As age related changes in the brain have not been systematically studied in the Indian population though there is an impression that they are less frequent, we studied 52 brains collected at autopsy from individuals above the age of 60 yr. The incidence of senile plaques (SPs) and neurofibrillary tangles (NFTs) together were found to increase with age from 21 per cent in the seventh decade to 33 per cent in the eighth decade and 54 per cent in the ninth decade, the increasing incidence of NFTs being statistically significant. The SPs were found both in the hippocampus and frontal cortex while NFTs were seen only in the hippocampus in non-demented aged individuals. In contrast, in the three cases of Alzheimer's disease (symbol: see text) AD studied, the NFTs and SPs were found in high density in both hippocampus and frontal cortex. By immunohistochemistry, various morphological forms of SPs were found to have beta amyloid protein consistently, while ubiquitin and phosphorylated neurofilament occurred variably. More number of SPs could be labelled by amyloid immunostaining than by conventional silver stains. The NFTs contained ubiquitin and phosphorylated neurofilament protein as the antigenic components, both in AD and normal ageing. The incidence of age related changes and their antigenic character in the limited sample studied from south India appears to be comparable to findings from the West. Multicentric studies on a large sample derived from different ethnic groups in India are needed to further evaluate these features.
    The Indian Journal of Medical Research 04/1997; 105:141-50. · 2.06 Impact Factor
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    ABSTRACT: We report the ultrastructural abnormalities of the leukocyte granules and the cytogenetic findings in a patient of Chediak-Higashi syndrome (CHS), who presented with cutaneous melanosis as the only clinical feature. The diagnosis of CHS was established by peripheral smear and bone marrow examination. Chediak-Higashi syndrome, a rare autosomal recessive disorder is characterized by enlarged abnormal organelles in leukocytes and other cells. An interesting aspect of our patient was the absence of recurrent infections or any other clinical stigmata. Ultrastructurally, the leukocytes and their precursors in the bone marrow showed characteristic homogenous and heterogenous giant inclusions of variable sizes and shapes. These represent the primary granules which enlarge to attain the giant abnormal size by fusion with other primary or secondary granules. Cytogenic study of the bone marrow cells showed monosomy of chromosomes 8 and 17 in 20 percent of the metaphases. Neither the gene nor the chromosomal abnormalities specific for CHS have been identified as yet and thus the significance of our cytogenetic finding is presently not clear.
    Indian Journal of Pathology and Microbiology 02/1997; 40(1):75-9. · 0.68 Impact Factor
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    ABSTRACT: Hemimegalencephaly (HME), a rare congenital abnormality characterized by unilateral enlargement of the cerebral hemisphere, is one of the less common causes of intractable seizures. We report a 6-month-old infant with uncontrolled seizures who was diagnosed to have a large mass lesion based on a CT scan. Postmortem examination revealed left-sided HME with pachygyria, widened cortex, indistinct grey-white junction, and distorted deep nuclear masses. Histological features included loss of cortical lamination, large atypical neurons with argyrophilic accumulations, ballooned cells, neuronal heterotopia, and astrocytosis with dystrophic calcification. The heterotopic neurons in the white matter were present in a radial pattern suggestive of aberrant neuronal migration. Several large neurons were dystrophic with cytoskeletal abnormalities like phosphorylated high molecular weight neurofilament and ubiquitin in the cytoplasm. However, typical neurofibrillary tangles with Congo red and tau positivity were not observed. Synaptophysin labelling was found to be decreased in the cortex, but some of the abnormal neurons had dense perisomatic label. The majority of the balloon cells were astrocytic in origin, being positive for glial fibrillary acidic protein and negative for the neuronal markers. Although the etiology of HME is not known, it provides an opportunity to study anomalous development of the brain and neuronal developmental abnormalities.
    Clinical neuropathology 01/1997; 16(1):17-22. · 1.34 Impact Factor
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    ABSTRACT: A colloid xanthogranuloma of the third ventricle is described. Presenting features were symptoms of raised intracranial tensions and two episodes of seizures. The pathogenesis, clinical and radiological features, differential diagnosis and treatment of this rare benign lesion are briefly discussed.
    Indian Journal of Pathology and Microbiology 08/1996; 39(3):221-3. · 0.68 Impact Factor
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    ABSTRACT: Evaluation of tolerance, toxicity, and feasibility of combining large fraction (5 Gy) radiotherapy with 2-deoxy-D-glucose (2DG), an inhibitor of glucose transport and glycolysis, which has been shown to differentially inhibit repair of radiation damage in cancer cells. Twenty patients with supratentorial glioma (Grade 3/4), following surgery were treated with four weekly fractions of oral 2DG (200 mg/kg body weight) followed by whole brain irradiation (5 Gy). Two weeks later, supplement focal radiation to the tumor (14 Gy/7 fractions) was given. Routine clinical evaluation, x-ray computerized tomography (CT), and magnetic resonance (MR) imaging were carried out to study the acute and late radiation effects. All the 20 patients completed the treatment without any interruption. The vital parameters were within normal limits during the treatment. None reported headache during the treatment. Mild to moderate nausea and vomiting were observed during the days of combined therapy (2DG + RT) in 10 patients. No significant deterioration of the neurological status was observed during the treatment period. Seven patients were alive at 63, 43, 36, 28, 27, 19, and 18 months of follow-up. In these patients, the clinical and MR imaging studies did not reveal any late radiation effects. Feasibility of administering the treatment (2DG + 5 Gy) is demonstrated by the excellent tolerance observed in all 20 patients. Further, the clinical and MR studies also show the absence of any brain parenchymal damage.
    International Journal of Radiation OncologyBiologyPhysics 05/1996; 35(1):103-11. · 4.52 Impact Factor
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    ABSTRACT: A case of disseminated Burkitt's lymphoma with nervous system involvement in a HIV negative 35 year old lady is described. She primarily presented with multiple cranial nerve palsies. At autopsy, diffuse involvement of parenchymatous organs and lymphomatous meningitis with conspicuous sparing of gastrointestinal system was observed. In addition, there was an unusual feature of paraneoplastic demyelinating peripheral neuropathy. Incidentally, a large hydatid cyst was also seen in the left lobe in addition to the lymphomatous involvement of the liver.
    Indian Journal of Cancer 10/1995; 32(3):116-20. · 1.13 Impact Factor
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    ABSTRACT: Pathomorphological features of 10 HIV positive individuals studied at autopsy and biopsy are described. Nine patients had evidence of neuro-AIDS and eight of them succumbed to various opportunistic infections. One surviving patient underwent a diagnostic lymph node biopsy which revealed tuberculous lymphadenopathy. Cryptococcal meningitis was the commonest CNS opportunistic infection, seen in five cases, with disseminated systemic cryptococcosis in two. The other opportunistic infections included toxoplasma encephalitis in two, with acanthamoeba infection in one patient. Pulmonary tuberculosis was noted in three patients while other bacterial infections such as meningococcal meningitis, pseudomonas septicaemia were observed in three and pneumocystis carinii pneumonia in one. One seropositive individual was clinically asymptomatic but succumbed to a road traffic accident. The brain in this case showed features of HIV associated early leucoencephalopathy. Bacterial infections caused by organisms other than Mycobacterium tuberculosis associated with AIDS are often underdiagnosed and should be considered, especially in developing countries. In cases of cryptococcal and tuberculous meningitis or multiple parasitic infections, the patients should be screened for associated HIV infection.
    The Indian Journal of Medical Research 05/1995; 101:134-41. · 2.06 Impact Factor

Publication Stats

260 Citations
72.91 Total Impact Points


  • 1990–2000
    • Dharwad Institute of Mental Health and Neurosciences
      Hubli, Karnātaka, India
  • 1998
    • National Informatics Centre
      New Dilli, NCT, India
  • 1995
    • National Institute of Mental Health and Neuro Sciences
      • Department of Neuropathology
      Bengalore, State of Karnataka, India