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In reply

Dr Kamin makes a valid point. He is correct in stating that the CT scans in our case did show indirect signs (mass effect) indicative of a focal lesion in the left frontal lobe; thus, the results were not truly "negative." Our point, however, was that unequivocal signs of focal intracerebral hemorrhage may be inconspicuous or absent in a case that is subacute and isodense. In these cases, which may include lesions either smaller than the one we illustrated or deep enough not to be detectable by sulcal effacement, the information provided by magnetic resonance imaging would settle the issue before potentially dangerous therapies are considered.

Carlos S. Kase, MD; Glenn D. Barest, MD
Boston, Mass

Arch Neurol. 2004;61:801.