Comments on "unilateral reversible posterior leukoencephalopathy syndrome after coiling of an aneurysm".

I write concerning the case described as Unilateral reversible posterior leukoencephalopathy syndrome after coiling of an aneurysm reported by Huijgen et al.1

The patient reported in this case study developed a very severe headache during triple-H therapy after coiling of an aneurysm. The abnormalities that developed on MRI are those of edema that followed the pattern of involving gyri and their underlying white matter. I have seen this pattern in two other patients who developed severe migraine (Fig. 1) Each had a history of migraine. The findings in each of my patients and the patient reported by Huijgen et al.1 were fully reversible. I am confident that these findings represent an unusually severe migraine syndrome and not posterior reversible encephalopathy syndrome. These clinical and MR findings have not been sufficiently reported in the literature.

Fig. 1

Fluid attenuated inversion recovery sequences of MRI scans. MRI show increased signal involving unilateral (A) or bilateral (but predominantly unilateral) (B1 and B2) gyri and their underlying white matter in two patients who developed severe migraine.