Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc
Journal website http://www.jocmr.org

Case Report

Volume 9, Number 9, September 2017, pages 812-819

Importance of Distinguishing Between Mitochondrial Encephalomyopathy With Elderly Onset of Stroke-Like Episodes and Cerebral Infarction

Figures

Figure 1.
Figure 1. MRI examinations from May 2014 showing the migratory lesions of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes. Cortical DWI (a) and FLAIR (b) sequences revealed hyperintensity in the left temporal lobe.
Figure 2.
Figure 2. MRI examinations from October 2014 showing the migratory lesions of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes. Cortical DWI (a) and FLAIR (b) sequences revealed hyperintensity in the right temporal lobe.
Figure 3.
Figure 3. CT scan of the brain from April 2016 of a case with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS). In retrospect, the additional clinical features and bilateral basal ganglia calcification (a and b) were suggestive of MELAS.
Figure 4.
Figure 4. MRI of the brain from April 2016 of a case with mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS). FLAIR (a) sequences revealed white matter and cortical laminar necrosis-like findings and the cortical atrophy in the right temporal lobe. (b) The cortical atrophy was recognized prominently in the cerebellar cortex.

Tables

Table 1. Summary of Published Cases of Patients Older Than 65 Years Who Presented With MELAS
 
Age at diagnosis (years)SexMain clinical featuresNeuroimaging findingsMutationReference
DM: diabetes mellitus.
67FSeizures, stroke-like episodes, hearing deficit, progressive higher brain function impairment and DMBilateral temporal lobe and basal ganglia calcificationm.3243A>GOur case
70FHeadaches, hearing deficit, DM and encephalopathyRight temporal and basal
ganglia calcification		m.3243A>GAurangzeb et al, 2014 [5]
66FEncephalopathy, proximal myopathy and DMLeft periventricular lacunar infarction and prominent calcification of the pineal gland and basal gangliam.3243A>GJones et al, 2004 [6]

 

Table 2. Features to be Considered in the Differential Diagnosis of MELAS in Elderly Cerebral Infarction Patients
 
CT: computed tomography; MRI: magnetic resonance imaging.
Recurrent stroke-like episodes
Head scans (CT and MRI) that are inconsistent with the main blood-vessel-dominant region
CT scans revealing calcification around the basal ganglia
Atrophy of the cerebrum
Sensorineural hearing loss from a young age
Progressive higher brain dysfunction
Emaciation
Presence of a family history
Recurrent seizures
Disturbances of consciousness