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Correspondence |

Irreversible Posterior Leukoencephalopathy—Reply

Vivien H. Lee, MD; Eelco F. M. Wijdicks, MD; Edward M. Manno, MD; Alejandro A. Rabinstein, MD
Arch Neurol. 2008;65(11):1545. doi:10.1001/archneur.65.11.1545-b.
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We thank Dr Lee for his interest in our recent article on RPLS. In our series, patients did not have documented permanent clinical deficits attributable to RPLS, although our outcome results are limited owing to the retrospective nature of the study. In our series, 4 patients with permanent radiographic injury underwent formal ophthalmologic examinations during the incident hospitalization (from 3-8 days after onset), which revealed diabetic changes, cotton-wool spots and hemorrhage, refractive error only, and normal examination results. No visual field defects were documented. Unfortunately, no patients had formal neuro-ophthalmologic testing on follow-up. Data from a patient with RPLS presenting with cortical blindness who was not included in this series demonstrated normal formal visual field testing results on follow-up despite residual MRI occipital lesions. Small radiographic lesions may not correspond to observable clinical deficits, although it is possible that more significant lesions may leave subtle residual deficits that may be revealed on formal perimetry or neurocognitive testing. Prospective studies with more rigorous testing in patients with RPLS may be necessary to detect residual subtle clinical manifestations of the condition.

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