To the Editor.—In the September issue of the Journal (126:370-371, 1973), Hurwitz et al describe the value of brain scanning in intracranial arterial occlusive disease in children. Characteristically, the scan will be positive initially and then will resolve later in the course of the disease. The authors comment, however, that the brain scan changes may require a week or more following arterial occlusion to develop. A sequence of negative-positive-negative is thereby established.
This brain scan sequence of negative-positive-negative, with the duration of each phase being quite variable, can be confused by cases such as those described by Prensky et al1 in which positive brain scans are seen in children with the recent onset of idiopathic focal epileptic seizures. Furthermore, it is well recognized that a child who has had a perhaps unwitnessed focal motor seizure can have an acute hemiparesis or "Todd's palsy,"2 just as children with intracranial