Characteristic Neuroimaging Findings in a Patient with Acute Metabolic Encephalopathy, Lactic Acidosis and Stroke-Like Episodes Syndrome Distinguishable from that of Acute Ischemic Stroke

Abstract

Metabolic encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome is characterized by encephalopathy mimicking acute stroke, which is rarely observed in adulthood. We present a case of a female who presented with several neurologic deficits and diagnosed with MELAS syndrome. Brain magnetic resonance imaging (MRI) showed acute lesions mimicking stroke, which were not compatible with specific vascular territories. Magnetic resonance spectroscopy showed lactate peaks in both symptomatic and asymptomatic area. Single proton emission computed tomography (SPECT) shows hyperperfusion in the same area. On follow-up image, MRI lesion nearly disappeared and hyperperfusion on SPECT changed into hypoperfusion. We discuss the clinical characteristics and image findings of our patient.