Stream of Consciousness

To the Editor: Blum and colleagues (April 5 issue) 1 report an interesting and instructive but unusual case of the posterior reversible encephalopathy syndrome (PRES) resulting from a common condition — obstructive uropathy related to benign prostatic hyperplasia. We would like to point out that the diagnosis was delayed by approximately 48 hours because ultrasonographic examination of the urinary tract was not performed in a timely manner. Early exclusion of obstruction is emphasized as a time-tested teaching point in patients presenting with azotemia and uremia because prompt reversal or clinically significant improvement is common after a (usually) simple intervention if the . . .