Can diffusion weighted magnetic resonance imaging help differentiate stroke from stroke-like events in MELAS?. Issue 2 (1st August 2000)

• Record Type: Journal Article
• Authors: Oppenheim, C; Galanaud, D; Samson, Y; Sahel, M; Dormont, D; Wechsler, B; Marsault, C
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 69:Issue 2(2000)
• Page Start: 248
• Page End: 250
• Publication Date: 2000-08-01
• Subjects: degenerative disease -- diffusion weighted image -- mitochondrial encephalopathy; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp.69.2.248
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : The precise mechanism of neurological symptoms in patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is still controversial. The diffusion weighted MR findings at the acute phase of a neurological event in MELAS are described and the pathophysiology of stroke-like lesion in the light of diffusion changes is discussed. Brain MRI was performed 2 days after the sudden onset of cortical blindness in a 25 year old patient with MELAS. Fluid attenuated inversion recovery (FLAIR) images showed multifocal cortical and subcortical hyperintensities located bilaterally in the frontobasal and the temporo-occipital lobes. Diffusion weighted images showed normal to increased apparent diffusion coefficient values in the acute left temporooccipital lesion and increased values in the older stroke-like lesions. These diffusion weighted findings support the metabolic rather than the ischaemic pathophysiological hypothesis for stroke-like episodes occurring in MELAS. Normal or increased apparent diffusion coefficient values within 48 hours of a neurological deficit of abrupt onset should raise the possibility of MELAS, especially if conventional MR images show infarct-like lesions.