Eelco F.M. Wijdicks, MD
Wijdicks EF. Noncardiogenic Pulmonary Edema in Marathon Runners. Ann Intern Med. 2000;133:1010-1011. doi: 10.7326/0003-4819-133-12-200012190-00024
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Published: Ann Intern Med. 2000;133(12):1010-1011.
TO THE EDITOR:
As a neurologist, I found it difficult not to respond to Ayus and colleagues' report (1). Before this preliminary communication is accepted as an original contribution to the literature, the neuroimaging and neurologic presentation should be clarified.
Although it may appear as such, brain edema in young persons is notoriously difficult to assess on computed tomography (CT) scan because these patients may lack sulci on multiple CT scan cuts (2). Often, slices through the vertex region are needed to address the sulci pattern, and only the disappearance of basal cistern and disappearance of white- and gray-matter differentiation (“featureless CT”) are radiologic indicators of brain edema. If brain edema has been suspected, a follow-up CT scan often shows a reappearance of sulci. None of these features are shown in Ayus and colleagues' figure. In this example, the authors also incorrectly compare a CT scan with a magnetic resonance imaging (MRI) scan. The CT scan shows a slice through the upper cerebellum, and the shown MRI, I would estimate, is two cuts higher at the level of the appearance of the posterior horns of the ventricles. In addition, the window width and window level should be known because changes in these measures may result in a “fuzzy brain edema–like” CT scan.
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