S Das

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

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Publications (24)35.25 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.
    No preview · Article · Jul 2000 · Neurology India
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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.
    No preview · Article · May 2000 · Acta Neuropathologica
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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.
    No preview · Article · Apr 2000 · Neurology India
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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.
    No preview · Article · Jan 2000 · Clinical neuropathology
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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.
    No preview · Article · Apr 1999 · Neurology India
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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.
    No preview · Article · Mar 1999 · Neurology India
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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.
    No preview · Article · Jan 1999
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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.
    No preview · Article · Nov 1998 · Clinical neuropathology
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    ABSTRACT: lntracranial plasma cell granulomas are a rare group of idiopathic inflammatory pseudotumours often mistaken for lymphoreticular malignancies and myeloproliferative disorders. The clinical and pathological findings in respect of four cases of intracranial plasma cell granuloma clinically diagnosed as meningioma and glioma are presented in this report. The range of microscopic features seen included a mixed cell population with predominance of plasma cells, absence of cellular atypia and mitosis, multinucleate giant cells, perivascular cuffing by inflammatory cells and emperipolesis. The major considerations in differential diagnosis of this lesion are discussed.
    No preview · Article · Jun 1998 · Neurology India
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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.
    No preview · Article · Jan 1998
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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.
    No preview · Article · Apr 1997 · The Indian Journal of Medical Research
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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.
    No preview · Article · Feb 1997 · Indian Journal of Pathology and Microbiology
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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.
    No preview · Article · Jan 1997 · Clinical neuropathology
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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.
    No preview · Article · Aug 1996 · Indian Journal of Pathology and Microbiology
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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.
    No preview · Article · Oct 1995 · Indian Journal of Cancer
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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.
    No preview · Article · May 1995 · The Indian Journal of Medical Research
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    ABSTRACT: Motor neuron disease, considered synonymous with amyotrophic lateral sclerosis (ALS), is seen frequently in India. Its aetiopathogenesis is one of the major enigmas in neuroscience. In India only a limited epidemiological data of this neurodegenerative disorder is available and the problem is further compounded by a lack of autopsy study on this devastating disease. We report the neuropathological findings of three autopsied cases diagnosed as amyotrophic lateral sclerosis on the clinical basis of weakness, wasting and fasciulations in all limbs. There was no involvement of the sensory, cerebellar and extra-pyramidal systems. Terminally all had profound respiratory muscle weakness as is the usual cause of death in patients with motor neuron disease. The major findings in the anterior horn cells of the spinal cord were significant and asymmetrical loss of motor neurons, increased central chromatolysis, presence of argyrophilic axonal spheroids, occurrence of Bunina bodies, hyaline bodies, and occasional neurofibrillary tangles. There was loss of axons in the anterior roots. Electron microscopic studies revealed accumulation of skeins of 10 nm neurofilaments, both in intraneuronal hyaline inclusions and the axonal spheroids. No definite temporal correlation in the evolution of the pathological lesions and the duration of the illness is evident in our study.
    No preview · Article · Jan 1995
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    ABSTRACT: A retrospective neuropathological and immunocytochemical study of 25 brain biopsies and/or autopsies with clinical and pathological diagnosis of sub- acute sclerosing panencephalitis was carried out with a special regard for localisation of measles virus antigen (MV Ag in the brain). The degree of gliosis, microglial response and demyelination were found to become intense with increase in the duration of illness. On the otherhand, intranuclear and/or cytoplasmic inclusion bodies were detectable when the duration of illness was short, suggesting their relation to relatively acute and sub acute phase of the illness. MV Ag was positive in 7/25 cases. These had a shorter course of illness compared to the antigen negative cases. Further, the amount of Ag was more in the early phases of the illness. This inverse correlation between the amount of Mv Ag in the brain tissue and length of the disease could explain the eventuals 'burning out' or disappearance of the viral antigen though the histological features are strongly suggestive of the diagnosis of SSPE.
    No preview · Article · Jan 1994

  • No preview · Article · Jun 1993 · Journal of acquired immune deficiency syndromes
  • T Asha · S K Shankar · T V Rao · S Das
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    ABSTRACT: The biopsy material obtained from lesions of CNS are subjected to squash smear technique for rapid diagnosis as it is easier to make and the cytological features of cells are well preserved. During the year 1982-1983 one hundred and seventy eight squash smears were made to offer rapid diagnosis to the operating surgeon. The diagnosis was verified on paraffin sections. Correct diagnosis was made in 87% of cases. Various lesions have distinct cytomorphological features on smears. These distinct characters and efficacy of the method are discussed.
    No preview · Article · Aug 1989 · Indian Journal of Pathology and Microbiology

Publication Stats

219 Citations
35.25 Total Impact Points


  • 2000
    • Dharwad Institute of Mental Health and Neurosciences
      Hubli, Karnātaka, India
  • 1987-1995
    • National Institute of Mental Health and Neuro Sciences
      • • Department of Neuropathology
      • • Department of Neurology
      Bengalore, State of Karnataka, India
  • 1985
    • Jawaharlal Nehru University
      • School of Life Sciences
      New Dilli, NCT, India