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Comment & Response |

Reversible Cerebral Vasoconstriction Syndrome or Posterior Reversible Encephalopathy Syndrome—Reply

Derek M. Sorensen, MD1,2
[+] Author Affiliations
1Pulmonary, Critical Care, and Respiratory Services, MedStar Washington Hospital Center, Washington, DC
2currently with Cox Institute, Department of Emergency Medicine, Boonshoft School of Medicine, Wright State University, Kettering, Ohio
JAMA Neurol. 2016;73(5):606-607. doi:10.1001/jamaneurol.2015.5110.
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In Reply I appreciate the letter from Nabavizadeh and Vossough regarding the case of reversible cerebral vasoconstriction syndrome (RCVS) I reported1 and their suggestion of posterior reversible encephalopathy syndrome (PRES) instead of RCVS as the diagnosis. The diagnostic criteria for RCVS2 were not fulfilled owing to incompleteness of the clinical presentation and medical history. After a second review of the medical record, it was seen that the patient initially presented to the emergency department for a severe headache after synthetic cannabinoid use. She developed the seizure on the way to the hospital, which resulted in a change in her presenting symptom. This does not clinically change the diagnosis because PRES can present with headache.3 The patient was normotensive on presentation to the emergency department and did not require any antihypertensive treatment during or after hospitalization, which is atypical for PRES but not exclusive.3

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May 1, 2016
S. Ali Nabavizadeh, MD; Arastoo Vossough, MD, PhD
1Division of Neuroradiology, Hospital of the University of Pennsylvania, Philadelphia2Perelman School of Medicine, University of Pennsylvania, Philadelphia
3Division of Neuroradiology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
JAMA Neurol. 2016;73(5):606. doi:10.1001/jamaneurol.2015.5104.
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