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S. K. Shankar , Sarala Das

Abstract

In paediatric age group the pathological changes in post infective hydrocephalic brains before and after shunt surgery was studied in autopsy material. The degree of ventricular dilation, the extent of ependymal loss were found to be variable. In the initial stages subependymal oedema was prominent, while at later stages gliosis predominated. Many epitheloid cell granulomas were observed projecting into the ventricle breaching the ependyma. Following shunt surgery, in hydrocephalics of long duration, though the intraventricular pressure was relieved, there was no significant structural restitution of the cortical mantle. A more detailed neuroanatomical studies need to be conducted for a proper correlation of the relationship between the structure and function of the cortical neuronal circuitary.

Keywords

Hydrocephalus, Post Meningitic Hydrocephalus, Shunt Surgery, Pathology of Hydrocephalus

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B. S. Dwaraknath , V. K. Jain , Sarala Das , B. S. Das

Abstract

The technique of flow-cytometry has been used to measure the cellular DNA content of human brain tumours using 4,6 -Diamidino-2-phenyl-indolehydrochloride (DAPI) as fluorochrome and chicken erythrocytes as internal standards. Results of this preliminary study on 64 brain tumours show that the DNA index of brain tumours is widely distributed (1.4 to 3.5) and the percentage proliferating fraction in tumours is significantly higher (22.0 ± 9) than the normal brain issues (8.3 ± 0.5). Multiple DNA indices were observed in some cases indicating the presence of different sub-populations of cells. Most of these were malignant tumours. An attempt to analyse the tumours taking both DNA index and percentage proliferating fraction together, indicate that such measurements could be useful in distinguishing more clearly between the malignant and benign tumours.

Keywords

Flow-cytometry, Brain Tumours, DAPI, Chicken Erythrocytes, DNA Index, Percentage Proliferating Fraction, Malignancy

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D. Nagaraja , S. K. Shankar , L. Krishna Murthy , Sarala Das

Abstract

Fiftyfive cases of subacute sclerosing panencephalitis (SSPE) seen over a period of 22 years were studied. All patients were below 22 years (range 3-22 years) with a male preponderance. The initial symptoms consisted of myoclonic jerks, generalised tonic clonic seizures and behavioural changes. The clinical course consisted of progressive intellectual deterioration with involuntary movements (myoclonic jerks in 96.36 per cent, choreo - athetosis in 26.63 percent) and pyramidal sings (50.9 percent). The characteristic electroencephalographic finding was slowing of the background with periodic complexes consisting of high voltage, slow waves (occasionally sharp waves and spikes). On histology a spectrum of changes characterised by Dawson's inclusion encephalitis, Pette and Dorings nodular panencephalitis and Van Bogaerts sclerosing encephalitis were observed. It is stressed that there three probably represent different stages of the same illness in evolution. Nearly 28 percent were dead in ten months and none showed any improvement or remission.

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T. Vasudev Rao , S. Mushtaq , Sarala Das , B. S. Das , S. K. Shankar

Abstract

A case of multiple sclerosis in association with an oligodendroglioma is presented. The aetiopathogenesis is briefly discussed. The unusual features were the clinically silent multiple sclerosis lesion and the associated diffuse oligodendroglioma, a combination hitherto not reported. The etiopathogenesis of such collisions is ill understood. Separate factors may initiate the lesion or a common agent can be oncogenic as well as cause demyelination. Tumour specific antibody can cross-react with myelin or reactive glia bordering plaques may show neoplastic transformation. Availability of computed tomography should reduce the number of undiagnosed or silent cases of multiple sclerosis and cerebral tumours.

Keywords

Neuro-ectodermal Tumour, Oligodendroglioma, Multiple Sclerosis

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E. Ramakrishna , S. K. Shankar , V. K. Jain , T. Hegde , B. S. Das , G. N. Narayana Reddy , Sarala Das

Abstract

Subarachnoid haemorrhage and aneurysms are believed to be rare in India. A review of the Indian literature reveals no large-scale autopsy studies of subarachnoid haemorrhage. The authors have made a retrospective analysis of 1538 consentive cranial autopsies done over a period of 7 years. Macroscopic subarachnoid haemorrhage was identified in 158 (10%) cases. Among these ruptured aneurysms were seen in 33 (21%), arteriovenous malformations in 10 (6%), intracerebral haemotoma in 73 (46%) and cortical venous thrombosis in 8.2%. No cause was found for the subarachnoid haemorrhage in 9(5.5%) despite a detailed pathological study.

Keywords

Subarachnoid Haemorrhage, Aneurysm, Intracerebral Haematoma, Cortical Venous Thrombosis, Autopsy

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T. Asha , S. K. Shankar , Sarala Das , T. Vasudev Rao , Y. Ramamohan , K. R. Vani , D. Nagaraja , S. R. Aroor , V. Ravi , K. Taranatha Shetty , B. A. Chandramouli

Abstract

Brain biopsy is one of the important investigative procedures for establishing a diagnosis in various progressive diseases of the nervous system. At present with the availability of more modern and sophisticated techniques, the need for sampling brain is becoming limited. However, in a few conditions it remains the only method for establishing the diagnosis. We have reevaluated 71 brain biopsies performed during the past 15 years regarding the diagnostic usefulness. In 48 cases a definite diagnosis could be made, 16 biopsies were abnormal but no definite diagnosis could be offered, while 5 biopsies were within normal limits. In two cases, the biopsy material was inadequate for study. Majority of the biopsies with definite diagnostic pathology were from cases of SSPE. The other conditions diagnosed histopathologically include dysmyelinating and demyelinating conditions like, Schilder's disease, Krabbe's disease, Canavan's disease, sundanophillicleukodystrophy, degenerate conditions like Lafora body disease, Creutzfeldt Jakob disease and Viral encephalitis of herpes simplex type. A multi disciplinary approach in study has helped in improving the diagnostic efficiency and evolving other modalities of investigations to limit the procedure of brain biopsy to only conditions, with no other alternative diagnostic procedure.

Keywords

Brain Biopsy, Neurodegenerative Conditions, SSPE, Canavan's Disease, Schilder's Disease, Leukodystrophy, CJD

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K. R. Vani , S. K. Shankar , V. Ravi , P. K. Shenoy , P. Satishchandra , T. Vasudev Rao , T. Asha , Sarala Das

Abstract

Role of immunocytochemical localization of Herpes Simplex Viral antigen in cytological preparations viz., brain biopsy smears and CSF cytospin, for a rapid and specific diagnosis of the encephalitis was evaluated. The antigen could be localised in the neurons of the brain biopsy and mononuclear cells in CSF, in three cases, thus helping in a rapid diagnosis and timely antiviral treatment. Failure to localise the antigen in another brain biopsy alerted to seek alternative diagnosis and avoid the expensive Acyclovir therapy. Immunocytochemical detection of HSV antigen in cytological preparations appears to be a very useful technique for diagnosis in neurological practice.

Keywords

Herpes Simplex Encephalitis, Rapid Diagnosis, Cytological Preparations, Immunohistochemistry

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