Discordance between cerebral oxygen and glucose metabolism, and hemodynamics in a mitochondrial encephalomyopathy, lactic acidosis, and strokelike episode patient.
A patient with mitochondrial encephalomyopathy, lactic acidosis, and strokelike episode (MELAS) syndrome underwent serial measurement of cerebral blood flow with xenon computed tomography (Xe-CBF) while presenting with strokelike episodes accompanied by a cerebral lesion. He underwent positron emission tomography (PET) measurement of the regional cerebral blood flow (PET-CBF), metabolic rate of oxygen (CMRO2), and glucose (CMRGlu) after his symptoms and lesion disappeared. During the symptomatic period, Xe-CBF and the Xe-CBF response to acetazolamide loading were well preserved both in and outside the low-density lesion. In the PET study, decreased CMRO2 and increased PET-CBF and CMRGlu were noted in the entire brain. The strokelike episodes of patients with MELAS are more likely attributed to the failure of oxygen metabolism than to a vascular accident.
Nariai
T
T
Neurosurgical Section, Brain Medical Science Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan. nariai.nsrg@tmd.ac.jp
Ohno
K
K
Ohta
Y
Y
Hirakawa
K
K
Ishii
K
K
Senda
M
M
D000086:Acetazolamide / Q000008:administration & dosage; D000328:Adult; D000927:Anticonvulsants / Q000008:administration & dosage; D002560:Cerebrovascular Circulation; D003937:Diagnosis, Differential; D005947:Glucose / Q000378:metabolism*; D006439:Hemodynamics; D006801:Humans; D017241:MELAS Syndrome / Q000175:diagnosis* / Q000378:metabolism*; D008279:Magnetic Resonance Imaging; D008297:Male; D010100:Oxygen / Q000378:metabolism*; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed / Q000379:methods; D014978:Xenon
D000927:Anticonvulsants; D014978:Xenon; D005947:Glucose; D000086:Acetazolamide; D010100:Oxygen