%0 Journal Article %A C Oppenheim %A D Galanaud %A Y Samson %A M Sahel %A D Dormont %A B Wechsler %A C Marsault %T Can diffusion weighted magnetic resonance imaging help differentiate stroke from stroke-like events in MELAS? %D 2000 %R 10.1136/jnnp.69.2.248 %J Journal of Neurology, Neurosurgery & Psychiatry %P 248-250 %V 69 %N 2 %X 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. %U https://jnnp.bmj.com/content/jnnp/69/2/248.full.pdf