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Biomedical subjects

N Knuckey

Publications and source records attributed to N Knuckey.

9 recordsLinked to original sources
PubMed2004

Longitudinal clivus fracture associated with trapped basilar artery: unusual survival with good neurological recovery.

A 46-year-old motorcyclist sustained severe cranio-facial fractures from a fall at 60 km/h. He gradually developed a left hemiparesis and diplopia but retained a GCS of 15. CT head scan revealed a longitudinal clivus fracture. MRA of intracranial vessels identified a trapped basilar artery. The patient made an excellent recovery with residual left abducens palsy on follow-up at 10 weeks. Such recovery with minimal residual deficit in the context of this injury has not previously been reported. Reported cases to date are reviewed and causative mechanisms discussed.

Accidents, Traffic↗
PubMed2001

Endovascular management of acute subarachnoid haemorrhage in the elderly.

The objective of this study was to analyse the technical and clinical outcome in elderly patients receiving endovascular treatment for acutely ruptured intracranial aneurysms. The case notes and angiograms of 14 patients over the age of 69 years undergoing endovascular treatment for subarachnoid haemorrhage within the Interventional Neuroradiology Unit, Royal Perth Hospital over a period of 6 years were retrospectively reviewed. The degree of angiographic occlusion achieved, and periprocedural, short-term and long-term clinical outcome were retrospectively assessed. Greater than 90% occlusion was obtained in 92% of cases. 82% of patients with Hunt and Hess grade I and II had an excellent clinical outcome. We conclude that endovascular coiling is an effective means of treating acute subarachnoid haemorrhage in grade I and II elderly patients.

Acute Disease↗
PubMed2001

Endovascular treatment of posterior circulation aneurysms.

The objective of this paper was to analyse the technical and clinical outcome in patients receiving endovascular treatment for posterior circulation intracranial aneurysms at Royal Perth Hospital. The case notes and angiograms of 35 patients with ruptured and unruptured posterior circulation aneurysms treated by endovascular coil occlusion between 1992 and 1998 were included in the study. The degree of angiographic occlusion achieved, and periprocedural, short and long-term clinical outcome were retrospectively analysed. Total aneurysm occlusion was achieved at initial treatment in 46% of cases, with 90% or greater occlusion achieved in 97% of cases. For aneurysms 12 mm or less in diameter, 100% of patients treated electively, and 100% of patients with grade I or II subarachnoid haemorrhage treated in the acute postictal phase had a good clinical outcome (Rankin Disability Score 1 and 2), with no serious morbidity or associated mortality. Excluding patients with grade V subarachnoid haemorrhage, the treatment-related serious morbidity rate was 3.4% and procedure-related mortality rate was 0%. We conclude that endovascular management provides an effective means of treatment for selected cases of posterior circulation aneurysms.

Adolescent↗
PubMed2001

Corticotroph pituitary carcinoma: case report and literature review.

Pituitary carcinomas, currently defined as primary adenohypophyseal neoplasms with evidence of either brain invasion or metastatic spread, are exceptionally rare. A case of corticotroph pituitary carcinoma is reported. A 17-year-old female first presented with an invasive and clinically non-functioning pituitary macroadenoma. The primary pituitary lesion lacked atypical histological features and retrospective immunohistochemical studies confirmed its corticotrophic nature. Repeated episodes of local recurrence followed together with the acquisition of severe Cushing's disease. Local disease control was not obtained despite repeated surgical decompression and courses of radiation therapy. Systemic dissemination with multiple bone metastases became manifest eleven years after the first presentation. Atypical histological features and Crooke's hyaline change were evident in both the recurrent and metastatic disease. She remains alive at last follow-up with severe complications relating to persisting sellar and metastatic disease and ongoing endocrine dysfunction. A further 32 cases of pituitary corticotroph carcinoma reported in English are reviewed to highlight the clinicopathological features of this rare form of pituitary neoplasm. Difficulties associated with the diagnosis and management of pituitary carcinoma are also discussed.

Adenoma↗
PubMed1999

Pituitary abscess.

A 28-year-old Caucasian woman presented with a 12 month history of secondary amenorrhoea, polyuria and polydipsia with fatigue and weight loss. Investigations revealed panhypopituitarism, diabetes insipidus, an intrasellar mass and papilloedema, thought to be due to benign intracranial hypertension. She was treated conservatively. However, a repeat magnetic resonance image showed enlargement of the pituitary mass with compression of the optic nerves. The pituitary abscess was drained by a transsphenoidal approach. Postoperatively the patient received antibiotics with no recurrence of the pituitary abscess. Copyright 1999 Harcourt Publishers Ltd.

Journal Article↗
PubMed1995

Choroid plexus electrolytes and ultrastructure following transient forebrain ischemia.

A temporal profile of lateral and fourth ventricle rat choroid plexus (LVCP and 4VCP, respectively) tissue injury and recovery was determined using alterations in K, Na, and H2O content and ultrastructure after 10 min of transient forebrain ischemia (TFI). At 0.5 h postischemia the LVCP displayed a maximum reduction in K content by 32% and a significant increase in Na content by 85% and H2O content by 22%. LVCP tissue K, Na, and H2O content returned to sham values by 24 h postischemia. Ultrastructural changes appeared more severe between 0.5 and 12 h postischemia, whereas by 24 h, normal ultrastructure was restored. Elevations in 4VCP tissue Na (P < 0.05) and H2O content, which were less than those in LVCP, gradually reached a maximum by 24 h compared with sham. No change in 4VCP tissue ultrastructure was observed. These results indicate that the LVCP tissue is more vulnerable than 4VCP in the bilateral carotid artery occlusion model but that it recovers in a timely manner after TFI. Furthermore, the ability of the LVCP tissue to rapidly recover suggests its functional importance in helping to restore brain homeostasis.

Animals↗
PubMed1989

Spinal epidural abscess. An infectious emergency. Case report and review.

Spinal epidural abscess is an unusual disease in the pediatric age group, requires early diagnosis and prompt surgical drainage to insure a good clinical outcome. Back pain and fever are usually the only presenting symptoms occurring before precipitous neurologic deterioration. The causative organism is most often Staphylococcus aureus, which presumably is spread to the epidural space hematogenously. Diagnosis is facilitated by computed tomography (CT) scan, but the entire spine must be imaged by either myelography or magnetic resonance imaging (MRI) to assess for skip lesions.

Abscess↗