Journal of Neurology, Neurosurgery & Psychiatry, 2018
IntroductionInitially described in Japan in 1957, moyamoya angiopathy is recognised in other popu... more IntroductionInitially described in Japan in 1957, moyamoya angiopathy is recognised in other populations, particularly within Europe and North America. Moyamoya disease (MMD) is a rare chronic progressive cerebrovascular disorder of unknown aetiology characterised by concentric stenosis of large intracranial vessels with collateralisation from moyamoya vessels and the leptomeningeal vessels. Affected individuals may present with transient ischaemic attacks or ischaemic stroke, however presentations with intracerebral haemorrhage, epilepsy or cognitive impairment in both children and adults also occur. Those with moyamoya syndrome (MMS), MMD in the setting of an associated disease such as neurofibromatosis, type one diabetes mellitus and trisomy 21, appear to follow a similar clinical course.MethodsWe conducted a retrospective review of patients with Moyamoya angiopathy who presented to the Townsville or Mackay Hospital Health Service between January 2012 and January 2018.ResultsWe i...
... W. Peter Vandertop. 1. de Witt Hamer PC, Verstegen MJ, van Furth WR, Bosch DA: Colloid cysts.... more ... W. Peter Vandertop. 1. de Witt Hamer PC, Verstegen MJ, van Furth WR, Bosch DA: Colloid cysts. J Neurosurg 92: 906-907, 2000 (letter). ... 6. Vandertop WP, Gosselaar PH, Nesselrooij B: Three sisters with colloid cyst of third ventricle. Lancet 346: 643-644, 1995 (letter). ...
ABSTRACT This article reviews the current knowledge of the pathogenesis, clinical features, diagn... more ABSTRACT This article reviews the current knowledge of the pathogenesis, clinical features, diagnostic evaluation, and treatment of intracranial aneurysms. The vast majority are acquired lesions, likely as a result of hemodynamic stress on the relatively unsupported bifurcations of the intracranial arteries. Cigarette smoking is an emerging important risk factor for their development. The natural history of unruptured aneurysms is controversial and may be subject to revision. A benign perimesencephalic pattern of subarachnoid hemorrhage has been recognized that usually is not due to a ruptured aneurysm. Current treatment includes surgical clipping and endovascular treatment with Guglielmi detachable coils, which produces comparable results in some instances. Epidemiologic studies suggest that the outcome of patients with aneurysmal subarachnoid hemorrhage remains poor, with a 30-day death rate of 45%, although the outcome of patients who reach the hospital alive may have improved in recent years.
Aquaporin-4 (AQP4) has been implicated in post-traumatic syringomyelia (PTS), a disease character... more Aquaporin-4 (AQP4) has been implicated in post-traumatic syringomyelia (PTS), a disease characterised by the formation of fluid-filled cysts in the spinal cord. This study investigated the expression of AQP4 around a mature cyst (syrinx) and the effect of pharmacomodulation of AQP4 on syrinx size. PTS was induced in male Sprague–Dawley rats by computerized spinal cord impact and subarachnoid kaolin injection. Immunofluorescence of AQP4 was carried out on mature syrinx tissue 12 weeks post-surgery. Increased AQP4 expression corresponded to larger, multiloculated cysts (R2 = 0.94), yet no localized changes to AQP4 expression in perivascular regions or the glia limitans were present. In a separate cohort of animals, at 6 weeks post-surgery, an AQP4 agonist (AqF026), antagonist (AqB050), or vehicle was administered daily over 4 days, with MRIs performed before and after the completion of treatment. Histological analysis was performed at 12 weeks post-surgery. Syrinx volume and length we...
Endothelial cells are highly sensitive to ionizing radiation, and exposure leads to multiple adap... more Endothelial cells are highly sensitive to ionizing radiation, and exposure leads to multiple adaptive changes. Remarkably, part of this response is the translocation of normally intracellular proteins to the cell surface. It is unclear whether this ectopic expression has a protective or deleterious function, but, regardless, these surface-exposed proteins may provide unique discriminatory targets for radiation-guided drug delivery to vascular malformations or tumor vasculature. We investigated the ability of an antibody–thrombin conjugate targeting mitochondrial PDCE2 (E2 subunit of pyruvate dehydrogenase) to induce precision thrombosis on irradiated endothelial cells in a parallel-plate flow system. Click-chemistry was used to create antibody–thrombin conjugates targeting PDCE2 as the vascular targeting agent (VTA). VTAs were injected into the parallel-plate flow system with whole human blood circulating over irradiated cells. The efficacy and specificity of fibrin-thrombus formati...
Purpose Superficial siderosis, a progressive, debilitating, neurological disease, often presents ... more Purpose Superficial siderosis, a progressive, debilitating, neurological disease, often presents with bilateral impairment of auditory and vestibular function. We highlight that superficial siderosis is often due to a repairable spinal dural defect of the type that can also cause spontaneous intracranial hypotension. Methods Retrospective chart review of five patients presenting with moderate to severe, progressive bilateral sensorineural hearing loss as well as vestibular loss. All patients had developed superficial siderosis from spinal dural defects: three after trauma, one after spinal surgery and one from a thoracic discogenic microspur. Results The diagnosis was made late in all five patients; despite surgical repair in four, hearing and vestibular loss failed to improve. Conclusions In patients presenting with progressive bilateral sensorineural hearing loss, superficial siderosis should be considered as a possible cause. If these patients also have bilateral vestibular loss,...
ObjectivesThis scoping review aims to synthesise the current evidence on the inclusion and effect... more ObjectivesThis scoping review aims to synthesise the current evidence on the inclusion and effectiveness of integrating evidence-based medicine (EBM) and shared decision-making (SDM) into training courses for doctors in training to enhance patient care. Both EBM and SDM appear to be taught separately and their combined role in providing high-quality patient care has not yet been explored.DesignScoping review of literature from January 2017 to June 2021.SettingAny setting where doctors in training could undertake EBM and/or SDM courses (hospitals, universities, clinics and online).ParticipantsDoctors in training (also known as junior doctors, residents, registrars, trainees, fellows) defined as medical graduates undertaking further training to establish a career pathway.MethodsSearches were conducted in the databases Medline, Embase, Scopus and Cochrane Library. Bibliographies of included articles and their cited references were hand searched and assessed for inclusion. Included stud...
Chiari malformation is characterised by the herniation of the cerebellar tonsils through the fora... more Chiari malformation is characterised by the herniation of the cerebellar tonsils through the foramen magnum. However, tonsillar herniation and other 2D morphometric measurements of the posterior cranial fossa (PCF) have a weak association with patients' symptoms and clinical outcomes. This study aimed to contrast current 2D metrics with a novel 3D shape analysis of the PCF and the hindbrain, to determine if 3D measurements provides further insight into the pathophysiology of Chiari. The cranium of 12 controls and 21 Chiari malformation patients with (N = 9) and without (N = 12) a syrinx were scanned. The morphology of the PCF was quantified with typical 2D measurements. Additionally, a correspondence-based shape model that normalised the PCF volume, was used to find 3D differences in the shape of the PCF, and the distance of the hindbrain from the inner surfaces of the PCF. Shape analysis showed that, compared to controls, the caudal (p = 0.007; 2.3 mm, IQR: 1.6-3.3 mm) and anterior (p = 0.027; 1.3 mm,IQR: 1.1-1.6 mm) surfaces of the hindbrain were closer to the PCF in patients with and without a syrinx, respectively. However, there were negligible differences in the shape of the PCF between patient groups (p > 0.39). Current morphometric measures should be normalised for variation in PCF volume, so that shape measures are not biased. The reduced CSF space between the hindbrain and PCF will alter CSF dynamics, which may compress cerebellar vasculature and contribute to patient symptomatology.
Journal of Neurology, Neurosurgery & Psychiatry, 2018
IntroductionInitially described in Japan in 1957, moyamoya angiopathy is recognised in other popu... more IntroductionInitially described in Japan in 1957, moyamoya angiopathy is recognised in other populations, particularly within Europe and North America. Moyamoya disease (MMD) is a rare chronic progressive cerebrovascular disorder of unknown aetiology characterised by concentric stenosis of large intracranial vessels with collateralisation from moyamoya vessels and the leptomeningeal vessels. Affected individuals may present with transient ischaemic attacks or ischaemic stroke, however presentations with intracerebral haemorrhage, epilepsy or cognitive impairment in both children and adults also occur. Those with moyamoya syndrome (MMS), MMD in the setting of an associated disease such as neurofibromatosis, type one diabetes mellitus and trisomy 21, appear to follow a similar clinical course.MethodsWe conducted a retrospective review of patients with Moyamoya angiopathy who presented to the Townsville or Mackay Hospital Health Service between January 2012 and January 2018.ResultsWe i...
... W. Peter Vandertop. 1. de Witt Hamer PC, Verstegen MJ, van Furth WR, Bosch DA: Colloid cysts.... more ... W. Peter Vandertop. 1. de Witt Hamer PC, Verstegen MJ, van Furth WR, Bosch DA: Colloid cysts. J Neurosurg 92: 906-907, 2000 (letter). ... 6. Vandertop WP, Gosselaar PH, Nesselrooij B: Three sisters with colloid cyst of third ventricle. Lancet 346: 643-644, 1995 (letter). ...
ABSTRACT This article reviews the current knowledge of the pathogenesis, clinical features, diagn... more ABSTRACT This article reviews the current knowledge of the pathogenesis, clinical features, diagnostic evaluation, and treatment of intracranial aneurysms. The vast majority are acquired lesions, likely as a result of hemodynamic stress on the relatively unsupported bifurcations of the intracranial arteries. Cigarette smoking is an emerging important risk factor for their development. The natural history of unruptured aneurysms is controversial and may be subject to revision. A benign perimesencephalic pattern of subarachnoid hemorrhage has been recognized that usually is not due to a ruptured aneurysm. Current treatment includes surgical clipping and endovascular treatment with Guglielmi detachable coils, which produces comparable results in some instances. Epidemiologic studies suggest that the outcome of patients with aneurysmal subarachnoid hemorrhage remains poor, with a 30-day death rate of 45%, although the outcome of patients who reach the hospital alive may have improved in recent years.
Aquaporin-4 (AQP4) has been implicated in post-traumatic syringomyelia (PTS), a disease character... more Aquaporin-4 (AQP4) has been implicated in post-traumatic syringomyelia (PTS), a disease characterised by the formation of fluid-filled cysts in the spinal cord. This study investigated the expression of AQP4 around a mature cyst (syrinx) and the effect of pharmacomodulation of AQP4 on syrinx size. PTS was induced in male Sprague–Dawley rats by computerized spinal cord impact and subarachnoid kaolin injection. Immunofluorescence of AQP4 was carried out on mature syrinx tissue 12 weeks post-surgery. Increased AQP4 expression corresponded to larger, multiloculated cysts (R2 = 0.94), yet no localized changes to AQP4 expression in perivascular regions or the glia limitans were present. In a separate cohort of animals, at 6 weeks post-surgery, an AQP4 agonist (AqF026), antagonist (AqB050), or vehicle was administered daily over 4 days, with MRIs performed before and after the completion of treatment. Histological analysis was performed at 12 weeks post-surgery. Syrinx volume and length we...
Endothelial cells are highly sensitive to ionizing radiation, and exposure leads to multiple adap... more Endothelial cells are highly sensitive to ionizing radiation, and exposure leads to multiple adaptive changes. Remarkably, part of this response is the translocation of normally intracellular proteins to the cell surface. It is unclear whether this ectopic expression has a protective or deleterious function, but, regardless, these surface-exposed proteins may provide unique discriminatory targets for radiation-guided drug delivery to vascular malformations or tumor vasculature. We investigated the ability of an antibody–thrombin conjugate targeting mitochondrial PDCE2 (E2 subunit of pyruvate dehydrogenase) to induce precision thrombosis on irradiated endothelial cells in a parallel-plate flow system. Click-chemistry was used to create antibody–thrombin conjugates targeting PDCE2 as the vascular targeting agent (VTA). VTAs were injected into the parallel-plate flow system with whole human blood circulating over irradiated cells. The efficacy and specificity of fibrin-thrombus formati...
Purpose Superficial siderosis, a progressive, debilitating, neurological disease, often presents ... more Purpose Superficial siderosis, a progressive, debilitating, neurological disease, often presents with bilateral impairment of auditory and vestibular function. We highlight that superficial siderosis is often due to a repairable spinal dural defect of the type that can also cause spontaneous intracranial hypotension. Methods Retrospective chart review of five patients presenting with moderate to severe, progressive bilateral sensorineural hearing loss as well as vestibular loss. All patients had developed superficial siderosis from spinal dural defects: three after trauma, one after spinal surgery and one from a thoracic discogenic microspur. Results The diagnosis was made late in all five patients; despite surgical repair in four, hearing and vestibular loss failed to improve. Conclusions In patients presenting with progressive bilateral sensorineural hearing loss, superficial siderosis should be considered as a possible cause. If these patients also have bilateral vestibular loss,...
ObjectivesThis scoping review aims to synthesise the current evidence on the inclusion and effect... more ObjectivesThis scoping review aims to synthesise the current evidence on the inclusion and effectiveness of integrating evidence-based medicine (EBM) and shared decision-making (SDM) into training courses for doctors in training to enhance patient care. Both EBM and SDM appear to be taught separately and their combined role in providing high-quality patient care has not yet been explored.DesignScoping review of literature from January 2017 to June 2021.SettingAny setting where doctors in training could undertake EBM and/or SDM courses (hospitals, universities, clinics and online).ParticipantsDoctors in training (also known as junior doctors, residents, registrars, trainees, fellows) defined as medical graduates undertaking further training to establish a career pathway.MethodsSearches were conducted in the databases Medline, Embase, Scopus and Cochrane Library. Bibliographies of included articles and their cited references were hand searched and assessed for inclusion. Included stud...
Chiari malformation is characterised by the herniation of the cerebellar tonsils through the fora... more Chiari malformation is characterised by the herniation of the cerebellar tonsils through the foramen magnum. However, tonsillar herniation and other 2D morphometric measurements of the posterior cranial fossa (PCF) have a weak association with patients' symptoms and clinical outcomes. This study aimed to contrast current 2D metrics with a novel 3D shape analysis of the PCF and the hindbrain, to determine if 3D measurements provides further insight into the pathophysiology of Chiari. The cranium of 12 controls and 21 Chiari malformation patients with (N = 9) and without (N = 12) a syrinx were scanned. The morphology of the PCF was quantified with typical 2D measurements. Additionally, a correspondence-based shape model that normalised the PCF volume, was used to find 3D differences in the shape of the PCF, and the distance of the hindbrain from the inner surfaces of the PCF. Shape analysis showed that, compared to controls, the caudal (p = 0.007; 2.3 mm, IQR: 1.6-3.3 mm) and anterior (p = 0.027; 1.3 mm,IQR: 1.1-1.6 mm) surfaces of the hindbrain were closer to the PCF in patients with and without a syrinx, respectively. However, there were negligible differences in the shape of the PCF between patient groups (p > 0.39). Current morphometric measures should be normalised for variation in PCF volume, so that shape measures are not biased. The reduced CSF space between the hindbrain and PCF will alter CSF dynamics, which may compress cerebellar vasculature and contribute to patient symptomatology.
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Papers by Marcus Stoodley