Successful use of intracavitary bleomycin for low-grade astrocytoma tumor cyst.

We report successful use of bleomycin in a low-grade astrocytoma tumor cyst of the tectal plate. A 6-year-old male underwent subtotal resection of a low-grade astrocytoma of the tectal plate followed by chemotherapy and proton beam radiation at age 2 and a half. Despite resolution of the solid portion of the tumor, serial MRI showed enlargement of a bilobar tumor cyst 3 years after the original diagnosis. The patient developed progressive ataxia, short-term memory loss and dysconjugate gaze. Following stereotactic placement of an Ommaya reservoir into the cyst, Isovue contrast and CT scan were used to confirm the integrity of the cyst. Five consecutive daily doses of 3.0 mg of bleomycin were instilled into the cyst after removal of cyst fluid. The therapy was well tolerated in the outpatient setting, and the clinical findings resolved. Subsequent CT and MRI at 4 months and 2 years after bleomycin confirmed no recurrence of the tumor or cyst.

Systematic approach to diagnosis and initial management of stroke.

Stroke is a medical emergency with high rates of mortality and morbidity. Ischemic stroke should be distinguished from hemorrhagic stroke. Indicators of hemorrhagic stroke include coma, vomiting, severe headache, a systolic blood pressure greater than 220 mm Hg and a blood glucose level of 170 mg per dL (9.4 mmol per L). Essential elements of the physical examination include assessment of level of consciousness, speech, cognitive abilities, visual fields, extraocular muscle function, motor function and gait. Computed tomography or magnetic resonance imaging should be performed. The main goal of treatment is to maximize physical and cognitive function by limiting acute complications and facilitating rehabilitation. The role of the family physician is to stabilize the patient's condition, coordinate a multidisciplinary team and guide the patient, as well as the patient's family, through the process of recovery.