Authors' reply

摘要

We thank Zhang and colleagues for their comments. In our paper we aimed to emphasise the clinical diagnosis in patients with PRES. We have previously reviewed childhood cases of PRES and found that most patients (76%) had at least three of four clinical cardinal manifestations, including seizures and headache (both 86%), altered mental status (66%), and visual disturbance (59%). All of these children had an abnormal routine MRI at diagnosis, and the detected changes improved after treatment. This analysis predated the widespread use of diffusion weighted imaging (DWI) and of apparent diffusion coefficient (ADC) mapping. We think that MRI is a confirmatory tool, but not a diagnostic tool in these patients. We agree that as a stand-alone neuroimaging technique, DWI is potentially nonspecific-in our experience, most centres undertake both ADC and DWI, and the two seem complementary. Furthermore, neuroimaging findings can be affected by a too-swift response to treatment of hypertension in these patients, leading to ischaemia. Both ADC and DWI findings might be affected in these circumstances.