Diagnostics neuropathology


Histopathology section:

The Histopathology section is unique in the country as it is the only one dedicated exclusively to examining neurological disorders. This section provides all aspects of diagnostics with main focus on biopsies from central and peripheral nervous system and skeletal muscle. The techniques employed include routine histopathological examination, specialized stains pertaining to neuropathology and immunohistochemistry, and electron microscopy.

The Department has six full time neuropathologists and offers comprehensive diagnostic services in the neuro-oncology, myopathology, peripheral nerve disorders, neuroinfections, neurodegenerative diseases and others. In recognition of its expertise, it receives referral samples that are almost double that of in-house biopsies. Facilities for immunohistochemistry and ultrastructural studies are available and employed whenever appropriate. (For detailed instructions on how to send a biopsy: Refer Clinician’s Handbook, Dept of Neuropathology).

The extensive and busy surgical neuropathology service evaluates approximately 9000 neurosurgical  biopsies annually, including in-house surgical cases (approx 3000) and referral consultations (approx 6000).  This is one of the few centres in the country for diagnosis of neuromuscudlar disorders resulting in a very large referral load. It’s the first centre in the country to set up enzyme histochemsitry, electron microscopy and immunohistochemsitry for diagnosis of muscle disorders. Annually we see approximately 1300 muscle biosiesand 1300 peripheral nerve biopsies. Neuro-Oncology Laboratory, Neuroimmunology and Neuromuscular Laboratory have been established at the Neurobiology Research Centre to provide advanced diagnostics and foster research. Molecular markers for brain tumors, high through put techniques, Mitochondrial respiratory chain analysis and Western blot techniques for muscular dystrophies have been initiated. Skin punch biopsy for the evaluatin of small fibre neuropathies has been established for the first time in the country on research mode in addition to serological work up for auto-immune disorders.

An active Comprehensive Epilepsy Program is ongoing that contributes large number of surgical epilepsy material, both in-house and referral consultations averaging 80 per year.

This division also engages in training histopathology technicians for man power development that will facilitate starting these specialised neuropathology techniques in other Institutes.

The Mortuary has an active autopsy service and conducts medicolegal during the day and clinical autopsies round the clock, including on holidays. The clinical autopsies are performed by the faculty and Post Doctoral Fellows of the Department. The brains are collected with written informed consent of the close relatives. Cases of HIV, tuberculosis, parasitic infections, stroke and tumors are some of the conditions that have been autopsied and have provided the much appreciated teaching and reference material housed in the Neuropathology Brain museum as well as material that is archived in the Human Brain Tissue Repository (Brain Bank) that provides this well characterised material for research (see section on Human Brain Tissue Repository (Brain Bank) for more details and Neuropathology Museum). The relatives of the deceased are permitted to keep the body in the freezers in the mortuary for 3-4 days for their convenience in performing the last rites.

Neuropathology Museum This is a unique museum showcasing more than 200 specimens related exclusively to neurological disorders including neurotrauma, neuroinfections, cerebrovascular disorders, development and brain tumors, making it the only one of its kind in the country. It is a rich teaching resource for medical fraternity. It is also open to public and has become a popular destination to visit for school children to learn the nuances of brain functioning and are fascinated by handling the real human brain. The lay people benefit as it helps demystify and destigmatise several of the brain disorders.

Electron microscopy section:

The sectionhas two transmission electron microscopes. It has contributed to the comprehensive study of muscle, nerve and brain pathology including diagnosis of metabolic disorders by skin biopsies. It is currently managed by Dr.Chandrashekar Sagar and the section provides much needed resources for training PhD students and assisting scientists, both from within NIMHANS and outside centres in their research.

Human Brain Tissue Repository or more popularly called the Brain Bank is a unique tissue bank, the only one of its kind in the country. It is the brain child of Prof.S.K.Shankar and was initially jointly supported by the Department of Science and Technology, Department of Biotechnology and Indian Council of Medical Research and is now taken over by NIMHANS and its operations are co-ordinated Dr.AnitaMahadevan. Fresh tissues of normal and diseased brain, collected at the time of autopsy, are made available to scientific investigators for research. Brain donation as a philanthrophic activity is now showing a gradual increase after the sustained efforts of Prof.S.K.Shankar and DrAnitaMahadevan to disseminate and educate the public about it.