Author Affiliations: Division of Critical Care Neurology, Mayo Clinic, Rochester, Minnesota.
We appreciate Dr Rozen's interest and thoughtful questions regarding our article. The 4 cases are undoubtedly outliers and unfortunately we have not identified any specific factors that may have predisposed them to a more fulminant—and eventually fatal—course. Three of 4 of our patients did undergo brain magnetic resonance imaging, and none of these showed evidence of a cerebrospinal fluid leak. One patient's magnetic resonance image showed mild cerebellar tonsillar descent below the level of the foramen magnum, but diffuse cerebral edema and basal cisternal effacement were also present, indicating that this was a result of increased intracranial pressure rather than cerebrospinal fluid hypotension.
Fugate JE, Wijdicks EFM, Rabinstein AA. Reversible Postpartum Cerebral Vasoconstriction Syndrome—Reply. Arch Neurol. 2012;69(6):792-793. doi:10.1001/archneurol.2012.214