Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS)

Case contributed by Dr Chris O'Donnell

Presentation

Two weeks of headache, blurred vision, reduced concentration.

Patient Data

Age: 45 years
Gender: Male

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Multiple bilateral areas of cortical and subcortical hypodensities in different vascular territories as well as bilateral basal ganglia calcification.

Widespread areas of apparent ischemia of varying ages in non-vascular territories, some with reduced ADC and some without. 

Diffuse edema in both occipital and temporal lobes, i.e. non-vascular territories. Occipital lesions are associated with restricted ADC but not the anterior right temporal lobe. Left anterior temporal lobe has minimal restricted diffusion

Considerable enhancement in left anterior temporal lobe consistent with laminar necrosis. 

Case Discussion

Widespread areas of apparent ischemia of varying ages in non-vascular territories, some with reduced ADC and some without - there is an ongoing debate about whether the stroke-like incidents in MELAS are ischemic or metabolic or both.          

This patient has a family history of mitochondrial disease.        

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