Serial diffusion imaging in a case of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes.

Abstract

BACKGROUND AND PURPOSE:

Most diffusion MRI studies of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episode stroke-like lesions report high- or normal-apparent diffusion coefficient, and this has been used to differentiate stroke-like lesion from ischemic stroke. There are, however, 3 recent reports of restricted diffusion in the acute phase of the stroke-like lesions. The purpose of our study was to investigate this apparent paradox.

METHODS:

We performed 9 serial MRI covering 2 stroke-like episodes in a 36-year-old man with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episode caused by the common mitochondrial DNA mutation 3243A>G.

RESULTS:

We found clear evidence of initial restricted diffusion in the stroke-like lesions, which gradually evolved to high-apparent diffusion coefficient as lesions aged. Evolution was, however, asynchronous with both high- and low-apparent diffusion coefficients temporally coexisting.

CONCLUSIONS:

Our findings suggest that cytotoxic edema does occur early in the course of a stroke-like lesions and that its presence or, conversely, the absence of vasogenic edema, should not weaken the possibility of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episode in favor of ischemic stroke.

• Authors: Charalampos Tzoulis, Laurence A Bindoff
• Journal: Stroke (Stroke) Vol. 40 Issue 2 Pg. e15-7 (Feb 2009) ISSN: 1524-4628 [Electronic] United States
• PMID: 19095975 (Publication Type: Case Reports, Journal Article)

Chemical References

• DNA

Topics

• Adult
• Brain (pathology)
• Brain Edema (pathology)
• DNA (genetics)
• Diffusion Magnetic Resonance Imaging (methods)
• Disease Progression
• Humans
• Image Processing, Computer-Assisted
• MELAS Syndrome (complications, genetics, pathology)
• Male
• Mutation