Short report
Can diffusion weighted magnetic resonance imaging help
differentiate stroke from stroke-like events in MELAS?
C Oppenheim* a, D Galanaud* a, Y Samsonb, M Sahela, D Dormonta, B Wechslerc, C Marsaulta
a Department of
Neuroradiology, Groupe Hospitalier Pitié-Salpêtrière, Paris VI
University, 47 Boulevard de l'Hôpital, 75651 Paris, Cedex 13, France, b Urgences
cérébro-vasculaires, c Department of Internal Medicine
Correspondence to: Dr Catherine Oppenheim catherine.oppenheim{at}psl.ap-hop-paris.fr
Received 22 November
1999 and in revised form 26 January 2000;
Accepted 23
March 2000
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.
Keywords: degenerative disease; diffusion weighted image ; mitochondrial encephalopathy
* These authors contributed equally to this work
© 2000 by Journal of Neurology, Neurosurgery, and Psychiatry
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