Browsing by Author "Sharad Pandey"

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A prospective pilot study on serum cleaved tau protein as a neurological marker in severe traumatic brain injury
(Taylor and Francis Ltd, 2017) Sharad Pandey; Kulwant Singh; Vivek Sharma; Deepa Pandey; Ravi Prakash Jha; Sunil Kumar Rai; Richa Singh Chauhan; Royana Singh
Objective: Neurotrauma has been labelled as a “silent epidemic” affecting both the developed and the developing nations. To date, no single brain-specific biomarker has been unanimously accepted for routine clinical use in TBI. Our study aims to determine the correlation of “cleaved-tau protein” in severe traumatic brain injury (TBI) with Glasgow Coma Scale (GCS) at the time of admission, mode of injury, CT findings and outcome at discharge. Methods: The study has been approved by the institutional ethical committee. 40 cases with severe TBI and 40 randomly selected healthy controls were included in this prospective study. Venous blood samples were collected and serum cleaved tau protein levels were measured and correlated with gender, mode of injury, CT findings GCS score and GOS score at discharge. Results: In the severe TBI group, the mean serum cleaved tau protein levels in males were 91.65 ± 41.34 pg/ml (mean ± S.D.), and females were 104.43 ± 53.08 pg/ml (mean ± S.D.), (p = 0.27). Mean serum C-tau level in study group was 95.48 ± 44.87 pg/ml (range 36.44-192.34), 95% C.I. (81.13–109.83) and in controls was 33.82 ± 13.65 pg/ml (range 2.48–66.54), 95% C.I. (29.46–38.19) (p < 0.001). The distribution of serum C-tau was in severe TBI group varied in all categories of GCS at 0th day (p < 0.001). Serum cleaved tau protein levels in the good outcome group were 74.26 ± 25.43 pg/ml (mean ± S.D.), range 36.44–144.54, 95% C.I. (63.52-85.00) and the poor-outcome group were 127.32 ± 49.40 pg/ml, range 66.65–192.34, 95% C.I. (100.99-153.64) (p = 0.001). Conclusion: In severe TBI, serum cleaved tau protein levels were significantly higher as compared to the controls in this prospective study. However, results of this study are preliminary in nature and there is a need to undertake larger prospective studies to reach a definitive conclusion. © 2017 The Neurosurgical Foundation.
Acquired dorsal intraspinal epidermoid cyst in an adult female
(Medknow Publications, 2016) Kulwant Singh; Sharad Pandey; Praveen Gupta; Vivek Sharma; Deepa Santhosh; Amrita Ghosh
Background: Epidermoid and dermoid cyst comprise <1% of spinal tumors and may be congenital (hamartoma) or acquired (iatrogenic) in origin. Epidermoid cysts within the neuraxis are rare benign neoplasms that are most commonly located in the intracranial region. Case Description: Here, we report the a case of an acquired intradural extramedullary epidermoid cyst involving the thoracic region in an adult female who had no associated history of an accompanying congenital spinal deformity. Conclusion: Early diagnosis and immediate surgical intervention reduce patient morbidity. Near complete or subtotal excision of the cyst wall is warranted to prevent inadvertent injury to the spinal cord thus minimizing neurological morbidity. © 2016 Surgical Neurology International.
Bilateral mirror image cervical neurofibroma in an adult with neurofibromatosis type 1
(Penerbit Universiti Sains Malaysia, 2017) Sharad Pandey; Kulwant Singh; Vivek Sharma; Mohammed Tabish Khan; Amrita Ghosh; Deepa Santhosh
Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterised by various phenotypic features like hyperpigmented spots, neurofibromas, Lisch nodules, skeletal abnormalities and tendency to develop neoplasms. Only few cases of Non-Familial Spinal Neurofibromatosis-1 (Non-FSNF1) have been described in literature with tumors involving the spinal roots at every level being even rarer. We reported an interesting case of bilateral symmetrical cervical neurofibroma with multiple spinal neurofibromas appearing as mirror image on CT, associated with non familial NF-1 as a rare presentation in a 25-year-old adult male. © Penerbit Universiti Sains Malaysia, 2017.
Bilateral occipital extradural hematoma in a child
(Wolters Kluwer Medknow Publications, 2015) Sharad Pandey; Vivek Sharma; Neeraj Shinde; Mukesh Sharma
Extradural hematoma (EDH) occurs in approximately 2% of all patients with head injuries. Bilateral EDHs account for 2-10% of all acute EDHs in adults but are exceedingly rare in children. Posterior fossa EDHs occurs in 5% of all cases of EDHs. EDHs in children are more frequently venous (from tears of a dural sinus or diploic veins) and consequently have a better prognosis than EDHs in adults. Once the diagnosis of BEH is confirmed, urgent surgical treatment should be considered. We are reporting such rare form of injury as bilateral occipital EDH with supratentorial extension in 12 years child following road traffic accident.
Bilateral Traumatic Intracranial Hematomas and its Outcome: a Retrospective Study
(Springer India, 2017) Sharad Pandey; Vivek Sharma; Kulwant Singh; Deepa Pandey; Mukesh Sharma; Deepak Bhanudas Patil; Neeraj Shende; Richa Singh Chauhan
The objective of this study was to evaluate the age distribution, mode of injury, type of hematomas, and their surgical outcome in patients with bilateral traumatic head injuries. The present study included 669 cases of traumatic head injury who presented at the neurosurgery emergency out of which 94 cases had bilateral head injuries from the period of August 2009 to April 2014. The data from the hospital computerized database were retrospectively analysed. Cases of bilateral traumatic head injury included 94 patients out of which 88.29 % (n = 83) were males and 11.70 % (n = 11) were females. Commonest mode of injury was road traffic accident in 56.38 % (n = 53) followed by fall from height in 29.78 % (n = 28). In our study, 25.53 % patients had epidural hematoma (EDH) with intracerebral hematoma (ICH) or contusion (n = 24), followed by EDH with subarachnoid hemorrhage (SAH) in 18.08 % (n = 17). At the time of discharge, all those patients managed conservatively had good Glasgow outcome scale (GOS) while with surgical intervention 58 % patients had good GOS, 19 % had moderate disability, and 9 % remained with severe disability. In cases of bilateral hematomas, EDH is most common and should be managed in neurosurgical emergency. Other combinations of bilateral intracranial hematomas should be managed according to the surgical indication and serial CT imaging. © 2015, Association of Surgeons of India.
Cerebral intraventricular echinococcosis in an adult
(Medknow Publications, 2015) Sharad Pandey; Deepa Pandey; Neeraj Shende; Anurag Sahu; Vivek Sharma
Background: Echinococcosis in humans occurs as a result of infection by the larval stages of taeniid cestodes of the genus echinococcus. Intracranial hydatid cysts usually develop at an intraparenchymal site. Hydatid cyst within the cerebral ventricle is quite unusual. Methods: We reviewed the literature on adult intraventricular hydatid cyst and found case reports mainly in children with an only handful of cases in adults. We reported a rare case of cerebral intraventricular (left lateral ventricle) hydatid cyst in a 21-year-old adult female. Results: Although cerebral hydatid cysts are most commonly seen in children and young adults cerebral intraventricular hydatid cyst are comparatively rarer in adults. Conclusion : The possibility of infection with Echinococcus granulosus should be included in the differential diagnosis of raised intracranial hypertension in patients from endemic areas. © 2015 Pandey S.
Clear cell sarcoma of the paraspinal ligament - A rare tumor at an unusual location: A review
(Wolters Kluwer Medknow Publications, 2016) Sharad Pandey; Anirudha Puntambekar; Vivek Sharma; Kulwant Singh; Deepa Santhosh; Amrita Ghosh; Abhijeet Kunwar
[No abstract available]
Dorsal spinal epidural psammomatous meningioma in an adult male
(Medknow Publications, 2016) Sharad Pandey; Kulwant Singh; Vivek Sharma; Amrita Ghosh; Saurabh Suman
Meningiomas are benign in nature and arise from the arachnoid cells. They are mostly situated in the intracranial compartment, whereas spinal meningiomas are rare. Approximately, in 10% of cases, an extradural component is seen but an exclusively extradural meningioma is quite uncommon. However, WHO Grade II (atypical) and Grade III (anaplastic) tumors can behave aggressively. We reported a case of purely extradural psammomatous meningioma in an adult male affecting the dorsal spine although uncommon meningiomas should be included in the differential diagnosis of extradural intraspinal masses.
Endoscopic Third Ventriculostomy in Cases of Hydrocephalus: An Institutional Experience
(Georg Thieme Verlag, 2019) Prarthana Saxena; Sharad Pandey; Pankaj Kumar; Kaviraj Kausik; Shiv Lal Soni
Background With the recent advances in optical and mechanical instrumentation, endoscopic third ventriculostomy (ETV) has emerged as the procedure of choice for the treatment of hydrocephalus in selected patients. Objective: To study the role of ETV in therapeutic management of hydrocephalus in a tertiary care center. Materials and Methods The present study was conducted in the Department of Neurosurgery at Dr. Ram Manohar Lohia Hospital. Endoscopic third ventriculostomy was performed as a therapeutic procedure in patients diagnosed with hydrocephalus requiring surgical intervention and admitted from June 2017 to July 2018. ETV success was defined by resolution or improvement in clinical symptoms and ETV failure was considered in patients whose symptoms either deteriorated or did not improve from the baseline and required ventriculoperitoneal shunt. Results A total of 85 patients were included in this study who underwent the therapeutic ETV. In the present study, the overall ETV success rate was 75.2% (64/85). 86.7% cases of aqueductal stenosis, 74.4% cases of post meningitis (including tubercular meningitis) hydrocephalus, and 71% of posterior fossa tumors showed resolution or improvement in clinical symptoms. Conclusion ETV is an effective treatment modality for obstructive hydrocephalus and with better results in post meningitis hydrocephalus and post tubercular meningitis hydrocephalus. However, more extensive studies dedicated to ETV with a larger sample size are required to further study its efficacy in various etiologies. © 2019 Neurological Surgeons' Society of India.
Epidemiological and clinico-radiological evaluation of head injury in pediatric population
(Wolters Kluwer Medknow Publications, 2020) Mukesh Sharma; Sharad Pandey; Praveen Kumar; Kulwant Singh; Pankaj Kumar; Ravi Prakash Jha
Background: Head injury in infancy and childhood has been documented as the single most common cause of death. In India, children aged <15 years constitute 35% of the total population and contribute to 20-30% of all head injuries. In this study, we attempted to analyze the epidemiological factors, management, and outcome of traumatic brain injury (TBI). The objective of this study were to find the causes of head injury in children and its pattern of distribution in this population and to analyze the efforts required to prevent the injury and management focusing on limiting the progression of primary brain injury and minimizing secondary brain insult. Results: A total of 2714 patients with head injury were admitted at our hospital during the study period and, out of them, 508 (18.17%) were pediatric patients with age less than 18 years. Of the 508 patients, only 497 patients were included in this study. In the present study, 357 (71.83%) were males and 140 (28.16%) were females. In total, 351 cases were managed conservatively whereas surgical intervention was conducted in 146 cases (P < 0.001). In this study, the most common mode of injury was a road traffic accident (RTA) (46.88%; n = 233), followed by fall from height (34.8%; n = 173) (P < 0.001). It was also seen that epidural hematoma and fracture hematoma were the most common computed tomography findings in pediatric patients with head injury followed by parenchymal contusion or contusion with or without fracture followed by diffuse axonal injury. A total of 344 cases out of 497 cases were discharged with Glasgow outcome score (GOS)-5 whereas nine cases remained in a persistent vegetative state (GOS-2). Conclusion: Early intervention aimed at the primary lesion in TBI in children generally carries a good outcome, and limits as much as possible the ongoing biomechanical, physiological, and pathological sequelae post-TBI. In teenagers, the importance of proper self-care along with adequate safety gears while doing any TBI-prone activity should be emphasized. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.
Homocysteine and vitamin B12: Other causes of neural tube defects in Eastern Uttar Pradesh and Western Bihar population
(Wolters Kluwer Medknow Publications, 2018) Rashmi Gupta; Preeti Kumari; Sharad Pandey; Deepika Joshi; Shiv Sharma; Sunil Rai; Royana Singh
Background: Neural tube defects (NTDs) are congenital malformations with an incidence of 1-10/1000 live births. Homocysteine and vitamin B12 metabolism have been shown to be associated with NTDs. Aim: To investigate the status of maternal and neonate's folic acid, homocysteine, and vitamin B12 levels and their association with the risk of development of NTDs in the population of Eastern Uttar Pradeshand Western Bihar, India. Materials and Methods: This study is a cross-sectional, retrospective study where 96 mothers who either had a first NTD child or had a history of NTD child in the family and 126 neonates with spina bifida were recruited during the period 2012-2015. Eighty-four control mothers whose previous and current pregnancies were normal, and 87 control neonates who had no defects and were within the same age range as the NTD affected neonates, recruited from the department of pediatric surgery, were enrolled in the study. Plasma concentrations of folic acid, vitamin B12, and homocysteine were compared between cases and controls. Results: The folic acid level in the mothers and neonates was within the normal limit. A significant increase in the level of homocysteine in mothers with affected pregnancy and in neonate cases in comparison to control mothers was obseved. Further, a significant decrease in the level of vitamin B12 in mothers with NTD neonates and in the affected neonates was noted. A negative correlation was found between homocysteine and vitamin B12 levels in case and control mothers. Conclusion: A correlation of an increase in serum homocysteine with a decrease in vitamin B12 was seen in mothers of neonates with NTD. A similar observation as made in the neonates with NTDs. It may be suggested that maternal decrease in vitamin B12, in mothers who have normal folic acid may be associated with NTD in their children. © 2018 Neurology India, Neurological Society of India | Published by Wolters Kluwer - Medknow.
Identification & characterization of leucine-rich repeat kinase 2 & parkin RBR E3 ubiquitin protein ligase variants in patients with Parkinson's disease
(Wolters Kluwer Medknow Publications, 2020) Tamali Halder; Shiv Verma; Janak Raj; Sharad Pandey; Ranjeet Singh; Vivek Sharma; Deepika Joshi; Parimal Das
Background & objectives: Parkinson's disease (PD) is a motor disorder that affects movement. More than 24 loci and 28 associated genes have been identified to be associated with this disease. The present study accounts for the contribution of two candidates, leucine-rich repeat kinase 2 ( LRRK2) and parkin RBR E3 ubiquitin protein ligase ( PRKN) in the PD patients, and their characterization in silico and in vitro. Methods: A total of 145 sporadic PD cases and 120 ethnically matched healthy controls were enrolled with their informed consent. Mutation screening was performed by direct DNA sequencing of the targeted exons of LRRK2 and all exons flanking introns of PRKN. The effect of the pathogenic PRKN variants on a drug (MG-132) induced loss of mitochondrial membrane potential (△ΨM) was measured by a fluorescent dye tetramethylrhodamine methyl ester (TMRM). Results: Twelve and 20 genetic variants were identified in LRRK2 and PRKN, respectively. Interestingly, five out of seven exonic LRRK2 variants were synonymous. Further assessment in controls confirmed the rarity of two such p.Y1527 and p.V1615. Among the pathogenic missense variations (as predicted in silico) in PRKN, two were selected (p.R42H and p.A82E) for their functional study in vitro, which revealed the reduced fluorescence intensity of TMRM as compared to wild type, in case of p.R42H but not the other. Interpretation & conclusions: About 6.2 per cent of the cases (9/145) in the studied patient cohort were found to carry pathogenic (as predicted in silico) missense variations in PRKN in heterozygous condition but not in case of LRRK2 which was rare. The presence of two rare synonymous variants of LRRK2 (p.Y1527 and p.V1615) may support the phenomenon of codon bias. Functional characterization of selected PRKN variations revealed p.R42H to cause disruption of mitochondrial membrane potential (△ΨM) rendering cells more susceptible to cellular stress. © 2020 Wolters Kluwer Medknow Publications. All rights reserved.
Ipsilateral double extradural hematoma in a child: An uncommon case
(Wolters Kluwer Medknow Publications, 2016) Sharad Pandey; Kulwant Singh; Vivek Sharma; Deepak Bhanudas Patil
Double extradural hematomas (DEDH) comprise 2-10% of all extradural hematomas (EDH). The ipsilateral occurrence of more than one EDH is quite uncommon. We are reporting a case of ipsilateral DEDH in a 10-year-old child following a head injury. Though DEDH is extremely lethal and a rare diagnosis, ipsilateral DEDH is still uncommon. Furthermore, the occurrence of EDH in the pediatric age group is quite unusual. As compared to single EDHs, DEDH should be considered more urgently for neurosurgical intervention. © 2016 Medical Journal of Dr. D.Y. Patil University | Published by Wolters Kluwer - Medknow
Pituitary Tuberculoma: An Uncommon Pathology
(Georg Thieme Verlag, 2021) Praveen Kumar Gupta; Sharad Pandey; Deepa Pandey
Pituitary tuberculomas are extremely rare with only few cases reported in the literature. Intracranial tuberculoma commonly presents with gradual onset of headache and visual disturbances with or without systemic symptoms. We reported such a case who presented with headache without any visual symptoms, occasional vomiting, and significant weight loss. Contrast magnetic resonance imaging scan was suggestive of pituitary macroadenoma. Transnasal transsphenoidal excision of the lesion (microscopic + endoscopic) was done. Histopathological examination revealed possibility of tuberculosis. Patient was put on standard antituberculosis treatment and discharged in a stable condition. © 2021 Georg Thieme. All rights reserved.
Uncommon presentation of choroid plexus papilloma in an infant
(Medknow Publications, 2016) Sharad Pandey; Vivek Sharma; Kulwant Singh; Amrita Ghosh; Praveen Kumar Gupta
Choroid plexus tumors are relatively rare primary brain tumors that arise from the epithelial differentiated tissue, majority being well-differentiated papillomas. In adults, fourth ventricle and in children, lateral ventricles are the most common site of these tumors. We reported a case of choroid plexus papilloma in the temporal horn of lateral ventricle in a female child who presented with the uncommon symptoms of sudden intraventricular hemorrhage and multiple episodes of seizure without symptoms of raised intracranial tension. © 2016 Journal of Pediatric Neurosciences.