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A 49-year-old woman with a known m.3243A>G tRNALeu(UUR) mutation (ie, the most frequent mutation in mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS)) diagnosed in the presence of migraine, diabetes mellitus, neurosensory hearing loss, short stature, cognitive deficit, ataxia and elevated lactate levels, presented with subacute aphasia and right hemiplegia. Brain MRI showed a typical stroke-like lesion in the left temporal and parietal lobe and prerolandic cortex. At this time, gradient-echo T2-weighted imaging showed hyperintensities in the involved regions (also visible on T2-weighted and FLAIR imaging, probably due to the …
Contributors DR and GT: substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; final approval of the version to be published.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.