title: Vasodilatation of multiple cerebral arteries in early stage of stroke-like episode with MELAS.
abstract: We describe a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS), with multiple cerebral vasodilatations in a stroke-like episode visualised by using magnetic resonance angiography (MRA) and CT angiography (CTA). In the acute stroke-like episode stage, T2-weighted and fluid-attenuated inversion recovery MRI showed high-intensity areas in the left occipital area. In addition, MRA and CTA revealed prominent dilatation of the left posterior cerebral artery and temporal branches of the middle cerebral artery with focal hyperperfusions using CT perfusion (CTP) that corresponded to the MRI. After 10 days, with the development of aphasia, MRI indicated the lesions had spread to the temporal and parietal regions, and this distribution was not confined to major vascular territories. The patient's symptoms gradually improved, accompanied by the attenuation of MRI, CTA, and CTP findings. These characteristic features along with the MRI changes that spread beyond vascular boundaries and the multiple cerebral vasodilatations prior to the development of clinical symptoms are not fully explained by the mitochondrial angiopathy or cytopathy theories. These findings provide further evidence supporting neuronal hyperexcitability in stroke-like episodes of MELAS.
authors.affiliation: Department of Internal Medicine, Tokyo Woman's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo 116-8567, Japan.
authors.forename: Shoko
authors.initials: S
authors.lastname: Minobe
authors.affiliation: Department of Internal Medicine, Tokyo Woman's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo 116-8567, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Matsuda
authors.affiliation: Department of Internal Medicine, Tokyo Woman's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo 116-8567, Japan.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Mitsuhashi
authors.affiliation: Department of Internal Medicine, Tokyo Woman's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo 116-8567, Japan.
authors.forename: Motonao
authors.initials: M
authors.lastname: Ishikawa
authors.affiliation: Department of Internal Medicine, Tokyo Woman's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo 116-8567, Japan.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Nishimura
authors.affiliation: Department of Internal Medicine, Tokyo Woman's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo 116-8567, Japan. Electronic address: kshbtgm@dnh.twmu.ac.jp.
authors.forename: Koichi
authors.initials: K
authors.lastname: Shibata
authors.affiliation: Department of Neurology, Tokyo Woman's Medical University, Shinjuku, Tokyo, Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Ito
authors.affiliation: Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan.
authors.forename: Yu-ichi
authors.initials: Y
authors.lastname: Goto
authors.affiliation: Department of Internal Medicine, Tokyo Woman's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo 116-8567, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Nakaoka
authors.affiliation: Department of Internal Medicine, Tokyo Woman's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa, Tokyo 116-8567, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sakura
mesh_terms: D001037:Aphasia / Q000209:etiology; D002533:Cerebral Angiography; D002536:Cerebral Arteries / Q000503:physiopathology*; D005260:Female; D006801:Humans; D017241:MELAS Syndrome / Q000503:physiopathology*; D018810:Magnetic Resonance Angiography; D009778:Occipital Lobe / Q000473:pathology; D020521:Stroke / Q000503:physiopathology*; D014664:Vasodilation; D055815:Young Adult
keywords: CTA; MELAS; MRA; Stroke-like episode; Vasodilatation