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Mitochondrial myopathy, encephalopathy, lactate acidosis with stroke-like episodes syndrome (MELAS): A case report

Petrović Igor N. (Klinika za neurologiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Mandić Gorana (Klinika za neurologiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Svetel Marina (Klinika za neurologiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Dragašević Nataša (Klinika za neurologiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Lačković Vesna (Institut za histologiju i embriologiju, Medicinski fakultet, Beograd)
Kostić Vladimir S. (Klinika za neurologiju, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)

Introduction. Mitochondrial encephalopathy, lactacidosis and stroke-like episodes (MELAS) represent a multisystemic dysfunction due to various mutations in mitochondrial DNA. Here we report a patient with genetically confirmed MELAS. Case Outline. A patient is presented whose clinical features involved short stature, easy tendency to fatigue, recurrent seizures, progressive cognitive decline, myopathy, sensorineural deafness, diabetes mellitus as well as stroke-like episodes. The major clinical feature of migraine type headache was not present. Neuroimaging studies revealed signs of ischemic infarctions localized in the posterior regions of the brain cortex. Electron microscopy of the skeletal muscle biopsy showed subsarcolemmal accumulation of a large number of mitochondria with paracristal inclusions in the skeletal muscle cells. The diagnosis of MELAS was definitively confirmed by the detection of a specific point mutation A to G at nucleotide position 3243 of mitochondrial DNA. Conclusion. When a relatively young patient without common risk factors for ischemic stroke presents with signs of occipitally localized brain infarctions accompanied with multisystemic dysfunction, MELAS syndrome, it is necessary to conduct investigations in order to diagnose the disease.

Keywords: acute brain stroke, seizures, lactacidosis, MELAS