title: Mitochondrial Encephalomyopathy Lactic Acidosis and Stroke-Like Episodes (MELAS): A Case Report and Critical Reappraisal of Treatment Options.
abstract: OBJECTIVE
  Stroke-like episodes signal progression and significant disability in the mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes syndrome. Arginine is widely used as a treatment for stroke-like episode, although there is little evidence for this intervention. We discuss the management of a patient with mitochondrial encephalomyopathy lactic acidosis and stroke-like episodes who presented with a stroke-like episode.
  
  
  METHODS
  During a seizure, which triggers the stroke-like episode, neurons are forced to utilize glycolysis as a source of adenosine triphosphate. Glycolytic by-products are damaging to the neuron. Breakdown of the blood-brain barrier leads to vasogenic edema.
  
  
  CONCLUSIONS
  Treatment of stroke-like episode should include anticonvulsants interictally to prevent seizures and dexamethasone ictally to help repair the blood-brain barrier.
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York. Electronic address: rf203@cumc.columbia.edu.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Fryer
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Bain
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, New York.
authors.forename: Darryl C
authors.initials: DC
authors.lastname: De Vivo
mesh_terms: D000927:Anticonvulsants / Q000627:therapeutic use; D002648:Child; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D017241:MELAS Syndrome / Q000175:diagnosis* / Q000628:therapy*
chemical_list: D000927:Anticonvulsants; D005938:Glucocorticoids; D003907:Dexamethasone
keywords: MELAS; arginine; aspirin; glycolysis; lactic acidosis; mitochondria; seizures; stroke-like episode