Hypertension and hypercholesterolemia were risk factors in spontaneous dissections, speaking for vascular wall abnormalities as potential contributors to pathophysiology of CAD. There was no evidence supporting one type of treatment over the other. A large ongoing prospective study should quell this controversy.

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A 33-year-old woman with history of occasional "migraines" complained of severe occipital headache, following an uncomplicated full-term vaginal delivery under epidural anesthesia. This headache was qualitatively and quantitatively different from her usual headaches. The diagnosis of low intracranial pressure headache related to inadvertent dural puncture was considered and 2 epidural autologous blood patches were performed with no relief. One week postpartum she presented to an outside hospital with complaints of poor concentration, difficulty in finding words, getting dressed, and feeding herself, and left arm numbness. Examination showed a blood pressure of 179/119 mm Hg, poor attention span, apraxia, and decreased sensation in the left hand. General physical examination was unrevealing.Head MRI (day 0) showed fluid-attenuated inversion recovery (FLAIR) hyperintensities (figure 1, A and B) and diffusion restriction with positive apparent diffusion coefficient (ADC) map (figure 1, C and D) in the right parietal lobe and in the splenium of the corpus callosum. The diagnosis of posterior reversible encephalopathy syndrome Upper panel MRI, performed on admission, showed FLAIR hyperintensities and diffusion restriction in the right parietal lobe and in the splenium of the corpus callosum (arrows). Lower panel, done on hospital day 3 when the patient deteriorated, showed worsening lesions involving the cortex and subcortical white matter of the parietal, posterior frontal, and occipital lobes, bilaterally (arrows).

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