In Reply We agree with Roohi’s opinion that in today’s era, medical decision making is strongly influenced by neuroimaging. However, we believe that it helps achieve a high level of diagnostic certainty in complex neurological situations.
Unfortunately, our patient had one of the rare neoplastic disorders affecting multiple organ systems and which typically presents with confounding the clinical picture and nonspecific laboratory and imaging findings.1 It has to be mentioned that approximately 50% to 80% of the cases are diagnosed only after autopsy, and many of the antemortem diagnoses are made incidentally in biopsies performed for different reasons.2- 4 Most of the cases reported in the literature are postmortem evaluations or are diagnosed after a biopsy.5,6 Most likely, this condition is underdiagnosed. This is not an excuse for why we did not diagnose this patient’s condition. As we mentioned in the article, our approach to diagnosing a presumed systemic condition was based on the clinical, blood workup, cerebrospinal fluid, bone marrow biopsy, imaging, and brain biopsy findings, all of which were nonspecific but mimicked acute disseminated encephalomyelitis.