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Patrick Lavin, MB, BCh
Nashville, Tenn

Arch Intern Med. 1986;146(7):1454.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

—Dr Garner makes three valid points that I will deal with in turn.

1. Sodium nitroprusside is not ideal, but should be the agent of choice because it is a powerful and predictably effective agent, without a direct effect on the central nervous system, and does not cause patchy ischemia.¹ It is currently favored by most experts in the field.^2-5 Its capacity to cause raised intracranial pressure is not clearly established.^6,7 Diazoxide, used in small frequent boluses, and -blockers, are also effective agents. However, newer agents such as captopril⁸ and the calcium channel blockers9 may prove more ideal.
   
2. The point that hydralazine hydrochloride caused neurologic deterioration as a result of raised intracranial pressure is well taken, however, the patient did not exhibit signs of raised
   

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