Clinical discriminators between acute brain hemorrhage and infarction: a practical scale for early patient identification

Abstract

In 1985, Takahashi et al. published the promising results of seven patients with craniopharyngioma treated with intratumoral bleomycin. Since then, two series (Broggi et al., 1989; Mottolese et al., 1996) of patients receiving the same type of treatment, with 18 patients each series, appeared in the literature. In this study we are presenting 21 patients, 10 males and 11 females, with predominantly cystic craniopharyngioma, submitted to this intratumoral modality of treatment. Their age span from 3 to 19 years old.Eleven cases were treated in neurosurgical departments in France and ten patients were treated in Brazil. The tumoral lesions were primary in 19 cases and recurrences in two cases. The length of time between the beginning of the symptoms and the diagnosis varied from one month to three years. The association of endocrine and visual symptoms and symptoms related to intracranial hypertension were the most common clinical presentations. Endocrinopathies as isolated symptoms were present in seven patients.The technique for insertion of the catheter in the tumor cyst was microsurgical through a craniotomy in nine cases, stereotactically in nine cases and through a burr hole in three cases. The dose of bleomycin used varied from 2 to 10 mg per injection. The injections of the drug were done daily or in alternated days. The average total doses of bleomycin was 60 mg for each cycle. Seventeen patients received only one cycle of bleomycin, while three patients received two cycles and one patient received three cycles. The length of the follow-up varied from three months to six years.The results were classified as good in 13/21 cases. Among them the tumor completely disappeared in three, and in nine patients occurred a reduction in size of more than 50%.The technique used in this series did not add any endocrinological morbidity. Two complications were detected: a transient optic neuritis during the second cycle of treatment and a seizure probably related to extratumoral leakage of the drug. Only three patients presenting with hydrocephalus demanded surgical diversion of cerebrospinal fluid before the intratumoral treatment with bleomycin.Six patients from the series were submitted to craniotomy for direct approach of the tumor after treatment with bleomycin. Three because of the cystic recurrence: two because of the complications previously mentioned and one to approach the solid part of the tumor. One patient received radiotherapic treatment for control of the solid part of the craniopharyngioma after treatment with bleomycin.

Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

“…In stroke, the mechanism behind symptom onset can be either an infarction through different mechanisms such as lacunar stroke, cerebral embolus, arteriosclerotic large vessel disease or a haemorrhage [7], whereas, in AMI, a fresh occluding or non-occluding thrombus is usually the cause of the symptoms, although other mechanisms such as hypotension or spasm are a possibility [8]. It is estimated that about 10% of all strokes are caused by a haemorrhage.…”