title: [A case with late-onset MELAS with hallucination and delusion].
abstract: We report a 53-year-old male patient with late onset mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes(MELAS) with hallucination and delusion. The patient manifested various neurological symptoms including perceptive deafness, muscle weakness of limbs with loss of consciousness, sensory abnormalities in hands, feet and a face, abnormal sense of taste, tremor, palsy of upward eye movement and weak deep tendon reflexes prior to the psychotic episode. He was diagnosed as MELAS, because of high serum lactic acid and pyruvic acid, and the point mutation in the mitochondrial DNA 3243. SPECT imaging showed decreased perfusion in occipital cortex and thalamus. These SPECT changes improved after disappearing visual hallucination. Hallucination might be caused by delirium due to stroke-like episode. Dysfunction in the occipital cortex and thalamus might be involved with this perfusion change.
authors.affiliation: Department of Psychiatry, Yokohama City University School of Medicine, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Narita
authors.forename: Toshinari
authors.initials: T
authors.lastname: Odawara
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kimura
authors.forename: Tomoki
authors.initials: T
authors.lastname: Yamada
authors.forename: Eizo
authors.initials: E
authors.lastname: Iseki
authors.forename: Kazuya
authors.initials: K
authors.lastname: Miyakawa
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hino
authors.forename: Daiji
authors.initials: D
authors.lastname: Kato
authors.forename: Kenji
authors.initials: K
authors.lastname: Kosaka
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Hirayasu
mesh_terms: D003702:Delusions / Q000209:etiology*; D006212:Hallucinations / Q000209:etiology*; D006801:Humans; D017241:MELAS Syndrome / Q000150:complications* / Q000523:psychology; D008297:Male; D008875:Middle Aged