Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episode (MELAS)
History of repeated seizures, persistent headaches, loss of consciousness and transient visual loss.
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Widespread confluent bilateral areas of T2/FLAIR hyperintensities seen in the cortical, subcortical and deep white matter not conforming to any arterial territory. These areas show no evidence of restricted diffusion on DWI/ADC, isointense signal to white matter on T1W without enhancement on T1+C. No evidence of hemorrhage on GRE.
Based on presenting symptoms and demographics, an assessment of Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) was made.
Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) is a rare inherited disorder that results in nervous system and muscle dysfunction and has distinct imaging findings.
This patient presents with history of seizures, loss of consciousness and loss of vision which she regained after some time (stroke-like symptoms) depicting neurological and muscular dysfunction.
The findings of confluent areas of ischemia not conforming to any vascular pattern as seen in this patient are typical in MELAS. Of note is the fact that the ischemic changes are not only seen in the parietal and occipital lobes, but also in the frontal lobes of both cerebral hemispheres.
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