i An update to this article is included at the end

American Journal of Emergency Medicine (2010) 28, 637-639

Correspondence

The differential diagnosis includes reversible cerebral vasoconstrictor syndrome

To the Editor,

The differential diagnosis of reversible leukoencephalo- pathy should include reversible cerebral vasoconstrictor syndrome. The suggestion that bilateral infarction of the Posterior cerebral arteries is the closest differential diagnosis of reversible posterior leukoencephalopathy syndrome probably applies to patients such as the one who featured in a recent report [1], who present without headache, but Alternative diagnoses such as reversible cerebral vaso- constrictor syndrome (RCVS) have to be considered in those who present with headache [2]. Notwithstanding that reversible cerebral edema has been the main focus in the imaging of RPLS [3] and reversibility of diffuse cerebral vasoconstriction the main focus in the imaging of RCVS [2], there is considerable overlap in the clinical and radiologic features of the 2 disorders [2,4-7].

Risk factors common to both disorders include the peripartum period and treatment with calcineurin inhibitors, respectively [2,5], and clinical stigmata that the 2 disorders have in common include hypertension, headache, seizures, focal neurologic deficits, and risk of recurrence [2,4]. Furthermore, diffuse multifocal segmental cerebral vasocon- striction, recognized as the hallmark of RCVS [2], may also be a feature of RPLS [6], and 9% of RCVS patients have been reported with “MRI (magnetic resonance imaging) FLAIR hypersignals consistent with RPLS” [2]. The overlap in radiologic stigmata between the 2 disorders is exemplified by the report of a patient presenting with hypertension, headache, and seizures in whom magnetic resonance imaging showed stigmata of RPLS, and angiography demonstrated diffuse reversible vasospasm [7].

Oscar M.P. Jolobe MB, ChB, DPhil

Manchester Medical Society C/o John Rylands University Library Manchester M13 9PP, UK

E-mail address: oscarjolobe@yahoo.co.uk

doi:10.1016/j.ajem.2010.03.030

References

1. Mankad K, Hoey E, Yap KS. reversible leukoencephalopathy syndrome. Am J Emerg Med 2010;28:386.e3-e5.
2. Ducros A, Boukobza M, Porcher R, Sarow M, Valade D, Bousser MG. The clinical and radiological spectrum of reversible cerebral vasocon- strictor syndrome. A prospective series of 67 patients. Brain 2007;130: 3091-101.
3. Bartynski WS. posterior reversible encephalopathy syndrome, Part 1: fundamental imaging and clinical features. Am J Neuroradiol 2008;29: 1036-42.
4. Lee VH, Wijdicks EFM, Manno EM, Rabinstein AA. Clinical spectrum of reversible posterior leukoencephalopathy syndrome. Arch Neurol 2008;65:205-10.
5. Hinchey J, Chaves C, Appignani B, Breen J, Pao L, Wang A, et al. A reversible posterior leukoencephalopathy syndrome. N Engl J Med 1996;334:494-500.
6. Bartynski WS, Boardman JF. Catheter angiography, MR angiography, and MR perfusion in posterior reversible encephalopathy syndrome. Am J Neuroradiol 2008;29:447-55.
7. Dodick DW, Eross EJ, Drazkowski JF, Ingall TJ. Thundercalap headache associated with reversible vasospasm and posterior leukoen- cephalopathy syndrome. Cephalalgia 2003;23:994-7.

Baseline drug history is also important for interpretation of the electrocardiogram

To the Editor,

Given the increasing recognition of the risk of narrow QRS complex proarrhythmia after “as required” self- administration of flecainide in patients with paroxysmal Atrial fibrillation [1], it seems prudent that over and above the documentation of age, sex, chief complaint, specific indication for the test, history of the present illness, medical history, and baseline electrocardiogram, the static algorithm [2] ought also to document cardiovascular drug history. In particular, the phenomenon of atrial flutter, with 1:1 conduction, but at a ventricular rate of 200 beats/min, or 2:1 atrioventricular block with a ventricular rate of 100 beats/ min, seems to be almost unique to narrow QRS complex proarrhythmia attributable to class 1 drugs such as flecainide which, in the process of organizing AF into atrial flutter,

0735-6757/$ – see front matter (C) 2010

Update

American Journal of Emergency Medicine

Volume 28, Issue 8, October 2010, Page 981

DOI: https://doi.org/10.1016/j.ajem.2010.07.013

Errata 981

Gilbert A. Leidig MD Anthony W. Clay DO John J. Kelly MD Ehsanur Rahman MD Section of cardiology department of Medicine

Christiana Care Health System Newark, DE 19718

DOI of original article: 10.1016/j.ajem.2009.09.005 doi:10.1016/j.ajem.2010.07.011

In the article “Timely identification of bacterial pathogens may reduce inappropriate antibiotic prescription” in the American Journal of Emergency Medicine 2010;28(4):519-520, there was an error in the byline. Dr Jolobe was incorrectly listed as an MD. The Correct byline is below.

Oscar M.P. Jolobe MB, ChB

DOI of original article: 10.1016/j.ajem.2010.01.022 doi:10.1016/j.ajem.2010.07.012

In the article “The differential diagnosis includes reversible cerebral vasoconstrictor syndrome” in the American Journal of Emergency Medicine 2010;28(5):637, there was an error in the byline. Dr Jolobe was incorrectly listed as an MD. The correct byline is below.

Oscar M.P. Jolobe MB, ChB

DOI of original article: 10.1016/j.ajem.2010.03.030 doi:10.1016/j.ajem.2010.07.013