To the Editor.—We do not share Dr. Winograd's belief that an abnormal blood or cerebrospinal fluid (CSF) glucose level is necessary to the diagnosis of Reye's syndrome. In accepting Reye's cases as a syndrome, Dr. Winograd must accept Reye's original data; a low blood or CSF glucose level was not uniformly present (CSF, 13/19; blood, 6/9). In Bradford and Latham's recent review article, a low blood glucose level was found in 27 out of 63 cases in which this determination was performed. A low CSF glucose level was found in 31 out of 59 cases.
It is our view, as emphasized in the title of our report, that hepatocellular dysfunction is primary and encephalopathy is a consequence of this. Presumably, the hypoglycemia encountered in many cases is also a consequence of hepatic dysfunction. A laboratory hallmark of this syndrome, which to date has always been present when sought, is