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Biomedical subjects

M O Fitzpatrick

Publications and source records attributed to M O Fitzpatrick.

17 recordsLinked to original sources
PubMed2006

Tectal plate cyst in adults.

Tectal plate cysts are very rare. We report two adult patients with benign tectal plate cyst and secondary hydrocephalus. The first patient had an unusual eye movement disorder with bilateral upper eyelid retraction (Collier's sign), limited upgaze, severe upgaze evoked nystagmus and retraction nystagmus. The second patient presented with ataxia and failure of upward gaze. Endoscopic fenestration of the tectal plate cyst and endoscopic third ventriculostomy in both cases result in neurological improvement. To the best of our knowledge, similar lesions at this site have not been reported in adults. The differential diagnosis with arachnoid cysts of the quadrigeminal CSF cistern is discussed.

Adult↗
PubMed2006

An unusual progression of benign thoracic spinal cord teratoma in pregnancy: a hormonally-mediated pathway?

Intradural spinal cord teratoma is a very rare tumour that can be associated with dysraphism. The relationship of this lesion to pregnancy is unknown and its occurrence during pregnancy in the thoracic spine has not been previously reported. We report a 19-year-old pregnant woman with spinal dysraphism, who presented with a new onset thoracic myelopathy. The MRI scan showed an intradural, extramedullary lesion with solid and cystic component in the thoracic spine at the level of T5-T6. A thoracic laminectomy and excision of this lesion was followed by significant improvement of her lower limb function. Histopathology confirmed a benign mature teratoma. The rapid progression of this lesion during pregnancy suggests a hormonal mediated pathway for the tumour growth. Further analysis from the resected specimen confirmed that the tumour was oestrogen and progesterone receptors positive.

Adult↗
PubMed2001

Endoscopic treatment of prepontine arachnoid cysts.

Prepontine (or suprasellar) arachnoid cysts are uncommon in clinical practice and experience in their management may therefore be limited. Symptomatic cysts usually present with features of hydrocephalus due to obstruction of the third ventricle and aqueduct, and occlusion or partial obstruction of both foramina of Monro. Several treatment techniques have been used including stereotactic aspiration, microsurgical excision and shunting, but the best method of treatment remains unclear and the role of endoscopy is not yet established. We report our experience in a series of seven patients who had endoscopic treatment for prepontine arachnoid cysts; five were children under 15 years old who presented with delayed development and/or enlarged heads. The two adult patients, both of whom had insertion of shunts as children, presented with headache and vomiting due to shunt blockage. All patients improved following endoscopic cyst fenestration. There was no operative morbidity and there have been no relapses to date. Endoscopic fenestration of prepontine arachnoid cysts appears to be an effective method of treatment.

Adolescent↗
PubMed2000

Thoracic radiculopathy caused by a myodil cyst.

We report the case of a myodil cyst causing a thoracic radiculopathy in a patient who had undergone a myelogram 30 years previously. Although myodil is no longer used, sequelae can continue to be seen for many years.

Contrast Media↗
PubMed2000

A standardised neurosurgical referral letter for the inter-hospital transfer of head injured patients.

OBJECTIVES: (1) To evaluate the use of a standardised neurosurgical referral letter in terms of compliance, completeness and clinical relevance. (2) To compare the clinical information provided on the standardised neurosurgical letter with that provided by referring hospitals that used alternative documentation. DESIGN: A six month prospective audit was conducted in south west Scotland. Consultant neurosurgeons were asked to weight key clinical variables on the neurosurgical referral letter (NRL). Postal surveys of 114 referring accident and emergency (A&E) staff and 18 neurosurgical receiving staff were undertaken to determine the clinical relevance of the NRL. Case notes were examined for the presence and level of completeness of the NRL. In the absence of the NRL, a form was completed retrospectively using data from the referring hospital's letter. This enabled comparison of the NRL with routine hospital letters in terms of the availability of key clinical information. RESULTS: 139 adult patients were identified as suitable for inclusion: 99 patients were transferred from 11 hospitals with access to the NRL. The compliance rate for use of the NRLwas 82%. Forty patients were transferred from nine hospitals that did not have access to the NRL. The completion rate of key variables on the NRL was higher than when an ordinary letter was sent: 87% compared with 38%. The NRL was considered useful by 67 of 71 (94%) A&E questionnaire respondents and by 14 of 15 neurosurgeons who responded. CONCLUSIONS: The widespread acceptance of the NRL and its ability to provide essential clinical information in a concise format not available in routine hospital letters indicates that national, standardised documentation can be implemented if users are involved in both its design and implementation.

Adult↗
PubMed1999

Metastatic liposarcoma of the brain: case report and review of the literature.

A 74-year-old woman presented with an acute left hemiplegia. CT demonstrated an irregular mass in the right parietal region of the brain. Two years previously, she had undergone wide local excision of a liposarcoma from her thigh. Craniotomy was performed and the lesion removed. Subsequent histology confirmed a liposarcoma. The brain is an exceptionally rare site of first recurrence of a liposarcoma. This case report presents a pathological rarity and briefly reviews the literature relevant to clinicians.

Aged↗
PubMed1999

Treatment limiting decisions in a neurosurgical unit.

In a previous paper on mortality audit we reported on the use of treatment limiting decisions (TLDs) in a neurosurgical unit in the year 1988. In this paper we compare the findings of a similar audit for 1997. It appears that our unit's policy of openly discussing all TLDs in patients who die had led to such decisions being made at a more appropriate stage in the patient's illness. Regular review of TLDs is probably helpful in increasing the confidence of clinicians to make these difficult decisions openly and timeously.

Cause of Death↗
PubMed1998

The neuronal cytoskeleton in acute brain injury.

The microtubules, neurofilaments and microfilaments of the neuronal cytoskeleton are essential for the normal functioning of the neurone. Recent studies have shown that disruption of the cytoskeleton may represent a final pathway in many types of neuronal cell injury with both the somato-dendritic and axonal cytoskeleton being affected. This review discusses the current evidence on the role of the neuronal cytoskeleton in the pathogenesis of traumatic brain damage.

Brain Injuries↗
PubMed1998

Golf related head injuries in children: the little tigers.

Head injury is a major cause of morbidity in Western society and sport related incidents account for approximately 11% of all head injured patients attending Accident and Emergency Departments. Golf was shown to be one of the sports most commonly associated with head injury requiring referral to a regional neurosurgical centre. Previous studies have demonstrated that it is predominantly children who sustain golf related head injuries which present either to an accident and emergency department or a regional neurosurgical centre. This study examines the number and pattern of golf related head injuries in children presenting to an accident and emergency department or requiring admission to the regional neurosurgical centre, over a three month period.

Age Distribution↗
PubMed1996

The neuronal cytoskeleton: an insight for neurosurgeons.

The cytoskeleton is important in the structure and function of the neuron. Disruption of the cytoskeletal proteins occurs in a variety of forms of acute brain injury including cerebral ischaemia and diffuse anonal injury. The final common pathway mediating neuronal cell death involves loss of the integrity of the cytoskeleton and these disturbances may have a key role in the progression of events following acute brain injury. This review aims to provide an insight into the neuronal cytoskeleton in the normal state and in disorders encountered in neurosurgical practice.

Axons↗
PubMed1996

Scalp lacerations demand careful attention before interhospital transfer of head injured patients.

Blood loss from scalp lacerations may be considerable. Two cases are described to illustrate the hazards of transferring patients with head injuries without adequate attention to scalp wounds. In such cases referring clinicians must be satisfied that haemostasis is secure. Failure to do this may place the patient at increased risk as a result of the need for additional resuscitation, and therefore delay the definitive management.

Adult↗