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Gramegna LL, Cortesi I, Mitolo M, Evangelisti S, Lia T, Cirillo L, Tonon C, Lodi R. Major cerebral vessels involvement in patients with MELAS syndrome: Worth a scan? A systematic review. J Neuroradiol 2021; 48:359-366. [PMID: 33596430 DOI: 10.1016/j.neurad.2021.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 11/30/2022]
Abstract
Major cerebral vessels have been proposed as a target of defective mitochondrial metabolism in patients with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS). Cerebral angiographic techniques are not routinely performed in MELAS patients. A systematic literature review was performed to identify studies describing major vessel caliber alterations in MELAS. Twenty-three studies reporting on 46 MELAS patients were included. Alterations in major caliber vessels were present in 59% (27/46) of patients. Dilation occurred in 37% (17/46) of patients, and in 88% (15/17) of them during a stroke-like episode (SLE). Stenosis was reported in 24% (11/46) of patients: 36% (4/11) related to an SLE and 64% (7/11) to dissections or degenerative changes. During an SLE, identification of intracranial vessels dilation or stenosis could be a selection tool for new treatment protocols. Outside SLE, identification of major cerebral vessels dissections and degenerative changes may help to prevent subsequent complications.
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Affiliation(s)
- Laura Ludovica Gramegna
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.
| | - Irene Cortesi
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Micaela Mitolo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Stefania Evangelisti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Talozzi Lia
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Luigi Cirillo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Caterina Tonon
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Functional and Molecular Neuroimaging Unit, Bologna, Italy; Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Raffaele Lodi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Tinsa F, Hechmi M, Hadj I, Khalsi F, Chargui M, Kefi R, Azouz H, Boussetta K, Abdelhak S. Thiamine responsive megaloblastic anemia mimicking mitochondrial disorders. Rev Neurol (Paris) 2019; 175:324-327. [DOI: 10.1016/j.neurol.2018.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 06/26/2018] [Accepted: 07/03/2018] [Indexed: 01/19/2023]
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3
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Savoiardo M, Strada L, Uziel G, Ciceri E, Antozzi C, Zeviani M. La risonanza magnetica nelle encefalomiopatie mitocondriali. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/19714009920050s105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Le encefalopatie mitocondriali sono un gruppo eterogeneo di malattie, in parte ancora in corso di definizione, per cui è sempre necessaria una conferma biochimica. Alcune malattie mitocondriali, come i difetti della β- ossidazione degli acidi grassi, possono causare gravi squilibri metabolici con ipoglicemia e coma che si ripercuotono in modo aspecifico sul sistema nervoso centrale determinando quadri di sofferenza cerebrale diffusa. Altre malattie mitocondriali determinano danni più specifici sul SNC. Nella prima infanzia la malattia più caratteristica è la malattia di Leigh, che determina alterazioni principalmente nel tegmento pontino e mesencefalico e nei nuclei della base. Alcuni casi presentano lesioni caratteristiche nei nuclei subtalamici, altri presentano reperti più aspecifici e diffusi simili a quadri di leucodistrofia. In età più tardiva (seconda infanzia o età adulta) la malattia più interessante dal punto di vista neuroradiologico è il MELAS, che presenta lesioni cortico-sottocorticali nelle regioni posteriori con distribuzione non tipicamente vascolare, sopra e sottotentoriali, che tuttavia possono essere ricondotte ai territori più distali dei vasi. Calcificazioni nei nuclei della base sono presenti in circa la metà dei casi. Un'altra encefalopatia mitocondriale dell'età giovanile o adulta è la sindrome di Kearns-Sayre, in cui la RM può dimostrare alterazioni nel tronco, nei talami, nei nuclei della base e nella sostanza bianca sottocorticale. Alterazioni nel neostriato possono essere osservate nelle sindromi distoniche associate ad atrofia ottica di Leber. Non sono descritte invece lesioni specifiche nel MERRF, in cui atrofia ed alterazioni della sostanza bianca sono state occasionalmente osservate. Esistono infine casi che presentano quadri clinici e neuroradiologici intermedi tra le varie sindromi mitocondriali. L'obiettivo di questa revisione è dimostrare alcuni aspetti tipici delle sindromi più comuni e indicare quali aspetti neuroradiologici, a volte inattesi, devono suggerire l'ipotesi di encefalopatia mitocondriale, permettendo cosi di indirizzare in modo corretto ulteriori indagini diagnostiche.
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Affiliation(s)
| | | | - G. Uziel
- Divisione di Neuropediatria, Istituto Nazionale Neurologico ‘C. Besta»; Milano
| | | | - C. Antozzi
- Divisione Malattie Neuromuscolari, Istituto Nazionale Neurologico ‘C. Besta»; Milano
| | - M. Zeviani
- Divisione di Biochimica e Genetica, Istituto Nazionale Neurologico ‘C. Besta»; Milano
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Pauli W, Zarzycki A, Krzyształowski A, Walecka A. CT and MRI imaging of the brain in MELAS syndrome. Pol J Radiol 2013; 78:61-5. [PMID: 24115962 PMCID: PMC3789935 DOI: 10.12659/pjr.884010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 03/12/2013] [Indexed: 11/17/2022] Open
Abstract
Background: MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, stroke-like episodes) is a rare, multisystem disorder which belongs to a group of mitochondrial metabolic diseases. As other diseases in this group, it is inherited in the maternal line. Case Report: In this report, we discussed a case of a 10-year-old girl with clinical and radiological picture of MELAS syndrome. We would like to describe characteristic radiological features of MELAS syndrome in CT, MRI and MR spectroscopy of the brain and differential diagnosis. Conclusions: The rarity of this disorder and the complexity of its clinical presentation make MELAS patients among the most difficult to diagnose. Brain imaging studies require a wide differential diagnosis, primarily to distinguish between MELAS and ischemic stroke. Particularly helpful are the MRI and MR spectroscopy techniques.
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Affiliation(s)
- Wojciech Pauli
- Diagnostic Imaging and Radiology Department of Public Hospital, Szczecin, Poland
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Tzoulis C, Bindoff LA. Acute mitochondrial encephalopathy reflects neuronal energy failure irrespective of which genome the genetic defect affects. Brain 2012; 135:3627-34. [PMID: 23065482 DOI: 10.1093/brain/aws223] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mitochondrial dysfunction and disease may arise as a result of mutations in either the mitochondrial genome itself or nuclear encoded genes involved in mitochondrial homeostasis and function. Irrespective of which genome is affected, mitochondrial encephalopathies share clinical and biochemical features suggesting common pathophysiological pathways. Two common paradigms of mitochondrial encephalopathy are mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes caused by maternally transmitted mutations of mitochondrial DNA and mitochondrial spinocerebellar ataxia and epilepsy caused by recessively inherited mutations of the nuclear-encoded DNA polymerase gamma, which replicates and repairs the mitochondrial genome. We studied and compared the disease mechanisms involved in these two syndromes. Despite having different genetic origins, their pathophysiological pathways converge on one critical event, damage to the respiratory chain leading to insufficient energy to maintain cellular homeostasis. In the central nervous system, this appears to cause selective neuronal damage leading to the development of lesions that mimic ischaemic damage, but which lack evidence of decreased tissue perfusion. Although these stroke-like lesions may expand or regress dynamically, the critical factor that dictates prognosis is the presence of epilepsy. Epileptic seizures increase the energy requirements of the metabolically already compromised neurons establishing a vicious cycle resulting in worsening energy failure and neuronal death. We believe that it is this cycle of events that determines outcome and which provides us with a mechanistic structure to understand the pathophysiology of acute mitochondrial encephalopathies and plan future treatments.
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Affiliation(s)
- Charalampos Tzoulis
- Department of Neurology, Haukeland University Hospital, 5021 Bergen, Norway.
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Lang C, Brenner P, HeuB D, Engelhardt A, Reichmann H, Seibel P, Neundörfer B. Neuropsychological status of mitochondrial encephalomyopathies. Eur J Neurol 2011; 2:171-6. [DOI: 10.1111/j.1468-1331.1995.tb00112.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Examples of single gene disorders have been described for all major subtypes of ischaemic stroke: accelerated atherosclerosis and subsequent thrombo-embolism (e.g. homocysteinuria), weakening of connective tissue resulting in arterial dissections (e.g. Ehler-Danlos type IV), disorders of cerebral small vessels (e.g. cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy and the collagen COL4A1 mutation), disorders increasing the thrombogenic potential of the heart through affecting the myocardium or the heart valves or through disturbance of the heart rhythm (e.g. hypertrophic cardiomyopathy), mitochondrial cytopathies increasing cerebral tissue susceptibility to insults (e.g. mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes), and finally disorders of coagulation that can either directly cause stroke or act synergistically with the aforementioned abnormalities (e.g. sickle cell disease). Most of these disorders are rare but they are important to consider particularly in young patients with stroke, those with a family history or those who have other characteristics of a particular syndrome.
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Affiliation(s)
- Enrico Flossmann
- Stroke Prevention Research Unit, University Department of Clinical Neurology, Radcliffe Infirmary, Oxford, UK.
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Abstract
OBJECTIVE To examine the neuropsychologic profile of MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes) and relate it to neuropathologic findings. BACKGROUND MELAS is one of over 40 mitochondrial disorders. Symptoms include seizures, strokelike episodes, headaches, memory impairment, hemianopsia, hearing loss, short stature, diffuse limb weakness, exercise intolerance, nausea, and vomiting. Age of onset ranges from 2 to 40 years. A hallmark of MELAS is normal development until the first symptoms appear. METHOD Because information regarding the neuropsychologic functioning of these individuals is sparse, we report findings from detailed neuropsychologic evaluations for a 13-year-old white male and a 33-year-old African-American male with MELAS. RESULTS Results revealed global patterns of deterioration in executive function, attention, language, memory, visuospatial, and motor functioning. In both patients, brain scans revealed posterior pathology in the absence of frontal pathology. CONCLUSIONS We compared our findings with other documented cases and concluded that MELAS is characterized by a pattern of global deterioration. This pattern differs from that observed in other mitochondrial disorders. The absence of identifiable frontal lobe pathology despite the presence of deficits in executive functioning may be related to the distribution patterns of deficient mitochondria and neuronal projection patterns.
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Affiliation(s)
- Sandy A Neargarder
- Psychology Department, Bridgewater State College, Bridgewater, MA 02325, USA.
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Amagasaki K, Shimizu T, Suzuki Y, Kakizawa T. Focal hyperperfusion in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes. Case report. J Neurosurg 2001; 94:133-6. [PMID: 11147883 DOI: 10.3171/jns.2001.94.1.0133] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A 28-year-old woman presented with mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS). The diagnosis was based on the results of molecular genetic analysis, which indicated a typical point mutation at the nucleotide pair 3243. Xenon computerized tomography scans obtained during the strokelike episodes revealed the lesion responsible for the symptoms to be an area of focal hyperperfusion, and scans obtained after the episodes revealed an area of hypoperfusion. Pathogenesis of the strokelike episodes appears to be metabolic dysfunction, although the involvement of a vascular event cannot be excluded.
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Affiliation(s)
- K Amagasaki
- Kanto Neurosurgical Hospital, Kumagaya, Saitama, Japan
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10
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Morin C, Dub� J, Robinson BH, Lacroix J, Michaud J, De Braekeleer M, Geoffroy G, Lortie A, Blanchette C, Lambert MA, Mitchell GA. Stroke-like episodes in autosomal recessive cytochrome oxidase deficiency. Ann Neurol 2001. [DOI: 10.1002/1531-8249(199903)45:3<389::aid-ana16>3.0.co;2-b] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Scharfe C, Hauschild M, Klopstock T, Janssen AJ, Heidemann PH, Meitinger T, Jaksch M. A novel mutation in the thiamine responsive megaloblastic anaemia gene SLC19A2 in a patient with deficiency of respiratory chain complex I. J Med Genet 2000; 37:669-73. [PMID: 10978358 PMCID: PMC1734685 DOI: 10.1136/jmg.37.9.669] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The thiamine transporter gene SLC19A2 was recently found to be mutated in thiamine responsive megaloblastic anaemia with diabetes and deafness (TRMA, Rogers syndrome), an early onset autosomal recessive disorder. We now report a novel G1074A transition mutation in exon 4 of the SLC19A2 gene, predicting a Trp358 to ter change, in a girl with consanguineous parents. In addition to the typical triad of Rogers syndrome, the girl presented with short stature, hepatosplenomegaly, retinal degeneration, and a brain MRI lesion. Both muscle and skin biopsies were obtained before high dose thiamine supplementation. While no mitochondrial abnormalities were seen on morphological examination of muscle, biochemical analysis showed a severe deficiency of pyruvate dehydrogenase and complex I of the respiratory chain. In the patient's fibroblasts, the supplementation with high doses of thiamine resulted in restoration of complex I activity. In conclusion, we provide evidence that thiamine deficiency affects complex I activity. The clinical features of TRMA, resembling in part those found in typical mitochondrial disorders with complex I deficiency, may be caused by a secondary defect in mitochondrial energy production.
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Affiliation(s)
- C Scharfe
- Department of Medical Genetics, Klinikum Innenstadt, Ludwig-Maximilians- University, Munich, Germany
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12
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Sue CM, Crimmins DS, Soo YS, Pamphlett R, Presgrave CM, Kotsimbos N, Jean-Francois MJ, Byrne E, Morris JG. Neuroradiological features of six kindreds with MELAS tRNA(Leu) A2343G point mutation: implications for pathogenesis. J Neurol Neurosurg Psychiatry 1998; 65:233-40. [PMID: 9703178 PMCID: PMC2170193 DOI: 10.1136/jnnp.65.2.233] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the neuroradiological abnormalities associated with subjects carrying the mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS) tRNA(Leu)(UUR) A3243G point mutation METHODS Mitochondrial genetic analysis was performed on 24 subjects from six kindreds with the MELAS tRNA(Leu)(UUR) A3243G point mutation. Cerebral CT and MRI were performed on 24 patients and 15 patients respectively. Previous neuroradiological investigations including cerebral CT from four deceased members of the families were also reviewed. Histological examination of postmortem specimens of two patients within the kindreds was performed. RESULTS The commonest radiological finding was basal ganglia calcification. Other abnormalities included focal lesions and cerebellar and cerebral atrophy. Basal ganglia calcification was progressive, symmetric, and asymptomatic. Histologically, basal ganglia calcification in one patient was found to be in the pericapillary regions of the globus pallidus, with no neuronal involvement. Focal lesions most commonly involved the grey matter of the parietal and occipital lobes and cerebellum. Histopathological examination suggested that these were due to cellular rather than vascular dysfunction. Enlargement of the fourth ventricle was the first sign of cerebellar atrophy. Cerebral and cerebellar atrophy were only present with severe disease. CONCLUSIONS These radiological findings, when considered in the context of the clinical and pathological findings, seem to reflect two major disease processes: an intermittent abrupt loss of function associated with cell injury from which there is at least partial recovery and a slowly progressive degenerative process causing basal ganglia calcification, and cerebral and cerebellar atrophy. The clinical and radiological features resulting from these processes are distinctive and provide insight into the consequences of mitochondrial dysfunction on the brain.
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Affiliation(s)
- C M Sue
- Department of Neurology, University of Sydney and Westmead Hospital, Australia
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13
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Takahashi S, Tohgi H, Yonezawa H, Obara S, Nagane Y. Cerebral blood flow and oxygen metabolism before and after a stroke-like episode in patients with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). J Neurol Sci 1998; 158:58-64. [PMID: 9667779 DOI: 10.1016/s0022-510x(98)00105-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cerebral blood flow and oxygen metabolism were examined in two patients with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) using positron emission tomography (PET). Regional cerebral blood flow (rCBF), regional cerebral oxygen metabolic rate (rCMRO2) and regional oxygen extraction fraction (rOEF) were determined with the steady-state technique using oxygen-15-labeled tracers (15O2, C15O2 and C15O). Case 1, a 45-year-old woman, presented with abrupt onset of fluent aphasia. T2-weighted magnetic resonance imaging (MRI) showed a high signal intensity lesion in the left temporoparietal region. The first PET study on day 16 showed increased rCBF and decreased rCMRO2 in the temporal region. In the second PET study, on day 35, rCBF in the temporal region had decreased. Case 2 was a 19-year-old male; the second son of Case 1. He complained of transient blurring of vision, and then generalized tonic-clonic convulsion occurred. A PET study six days before this stroke-like episode demonstrated increased rCBF in both frontal lobes and putamen, where MRI showed lesions after the episode. Focal hyperemia of the lesion antedated and lasted for at least sixteen days after the stroke-like episode in these MELAS patients. These stroke-like episodes appear to be the result of metabolic dysfunction in neural tissue, although the role of an ischemic vascular event cannot be ruled out.
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Affiliation(s)
- S Takahashi
- Department of Neurology, Iwate Medical University, Morioka, Japan
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14
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Silbert L, Durocher A, Biller J. The “S” in MELAS. J Stroke Cerebrovasc Dis 1996; 6:67-71. [PMID: 17894971 DOI: 10.1016/s1052-3057(96)80005-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/1996] [Accepted: 09/09/1996] [Indexed: 11/30/2022] Open
Abstract
MELAS syndrome is one of several mitochondrial-inherited encephalomyopathies distinguished from the others by its unique stroke-like episodes. A case is presented that illustrates the importance of acknowledging the heteroplasmic nature of this disease when making its diagnosis. The mitochondrial DNA (mtDNA) point mutation characteristic of MELAS was eventually detected by analysis of a muscle biopsy specimen after initial studies of a serum sample were negative for the same genetic defect. Other diagnostic features of MELAS syndrome are described; these include characteristic computed tomography (CT), magnetic resonance imaging (MRI), angiography, single photon emission computed tomography using N-isopropyl-p-[123-I]-Iodoamphetamine (IMP-SPECT), and pathological findings. Finally, various theories regarding the etiology of stroke in MELAS syndrome as well as available treatment options are discussed.
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Affiliation(s)
- L Silbert
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
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15
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Ito J, Tanaka H, Cho K, Kusunoki Y, Miyamoto A, Oki J. A patient with MELAS and arterial occlusive findings on cerebral angiography. J Child Neurol 1995; 10:337-9. [PMID: 7594272 DOI: 10.1177/088307389501000422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- J Ito
- Department of Pediatrics, Asahikawa Habilitation Center for Disabled Children, Japan
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16
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Hirano M, Pavlakis SG. Mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS): current concepts. J Child Neurol 1994; 9:4-13. [PMID: 8151079 DOI: 10.1177/088307389400900102] [Citation(s) in RCA: 221] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes (MELAS) syndrome is one of many mitochondrially inherited multisystem diseases. The features of 110 reported mitochondrial encephalomyopathy, lactic acidosis, and strokelike episodes patients are reviewed to define the clinical spectrum of this disease. The clinical disorder, in addition to emerging concepts of genetic etiology, is promoting our understanding of mitochondrial functions. New knowledge may lead to more rational therapies. Finally, the recent revolution in the study of mitochondrial diseases may further our understanding of other degenerative disorders and even aging.
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Affiliation(s)
- M Hirano
- Department of Neurology, Columbia-Presbyterian Medical Center, New York, NY
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17
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Ujike H, Wakagi T, Kohira I, Kuroda S, Otsuki S, Sato T. MELAS without ragged red fibers or lactic acidosis diagnosed by mitochondrial DNA testing. THE JAPANESE JOURNAL OF PSYCHIATRY AND NEUROLOGY 1993; 47:637-41. [PMID: 8301880 DOI: 10.1111/j.1440-1819.1993.tb01810.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A case of mitochondrial encephalomyopathy with lactic acidosis, a stroke-like episode (MELAS) without ragged red fiber, diagnosed by mitochondrial DNA testing, is reported. A 37-year-old woman experienced a sudden and recurrent headache with vomiting and stroke-like episodes. Brain CT and MRI showed multiple infarction in the temporal lobes, not corresponding to artery distribution. However, the plasma levels of lactate and pyruvate were normal, and showed no increased after aerobic exercise. Biopsied muscle showed no evidence of ragged red fibers and deficient activity of mitochondrial enzymes in the respiratory chain. The final diagnosis was made by mitochondrial DNA testing. A southern blot analysis after Apa I digestion revealed the A-to-G mutation in the tRNA(Leu(UUR)), which is specific to MELAS.
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Affiliation(s)
- H Ujike
- Department of Neuropsychiatry, Okayama University Medical School, Japan
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18
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Chen RS, Huang CC, Lee CC, Wai YY, Hsi MS, Pang CY, Wei YH. Overlapping syndrome of MERRF and MELAS: molecular and neuroradiological studies. Acta Neurol Scand 1993; 87:494-8. [PMID: 8356881 DOI: 10.1111/j.1600-0404.1993.tb04143.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We describe a 42-year-old woman with overlapping syndrome of MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes) and MERRF (myoclonus epilepsy and ragged-red fibers). Clinically, she had episodic headache, stroke-like episode with left hemiparesis and lactic acidosis commonly found in MELAS syndrome. However, myoclonus seizure, and ataxia with dyssynergic gait characteristic of MERRF were also noted. Computed tomographic scans showed a right temporo-parietal hypodense lesion. The lesion disappeared 20 months later, even magnetic resonance images also failed to reveal this abnormality. A molecular analysis of mitochondrial DNA was conducted by using restriction endonucleases ApaI and NaeI. A transition from A to G was found at the nucleotide position 3243, but not found at the 8344th nucleotide pair. In this report, we document the fluctuating CT changes and emphasize the importance of molecular analysis in patients with overlapping syndrome of mitochondrial encephalomyopathies.
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Affiliation(s)
- R S Chen
- Department of Neurology, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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19
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Ooiwa Y, Uematsu Y, Terada T, Nakai K, Itakura T, Komai N, Moriwaki H. Cerebral blood flow in mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes. Stroke 1993; 24:304-9. [PMID: 8421833 DOI: 10.1161/01.str.24.2.304] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND AND PURPOSE The precise mechanism of neurological symptoms with mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS) is still controversial. We investigated the correlation between strokelike episodes and cerebral blood flow in two patients with MELAS and discuss the pathogenesis of strokelike episodes with MELAS. SUMMARY OF REPORT Cerebral dynamic computed tomography and cerebral angiography were used to measure cerebral circulation in the first case, that of a 20-year-old woman with MELAS. The second subject was a 13-year-old female who was studied with xenon-enhanced computed tomography. The cerebral blood flow studies were performed 3-72 hours after the onset of strokelike episodes. Serial cerebral angiography, dynamic computed tomography, and xenon-enhanced computed tomography showed vasodilation localized in the affected cerebral cortexes during strokelike episodes, without any reduction in regional cerebral blood flow. CONCLUSIONS Our study suggests that the strokelike episodes associated with MELAS are different in origin from ischemic stroke.
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Affiliation(s)
- Y Ooiwa
- Department of Neurological Surgery, Wakayama Medical College, Japan
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Abstract
It has been suggested that dystonia is caused by an autosomal gene with reduced penetrance and a consequent biochemical abnormality affecting cell activity within the basal ganglia. No consistent biochemical disturbance has been identified. In the present study, activities of the mitochondrial electron transfer complexes were measured in platelets of 31 patients with idiopathic dystonia. Enzyme assays of these patients were compared to measurements in 28 control subjects. A significant decrease of complex I activity was observed in the majority of the patients, whereas the activities of other electron transfer complexes were normal. The severity of the complex I defect was more pronounced in patients with the segmental or generalized form than in those with focal dystonia. Complex I activity was not age dependent in the patients or control subjects. Although the electron pathway in complex I is disturbed in patients with idiopathic dystonia, complex I protein content seems to be normal. Whether abnormalities of complex I activity play a role in the pathogenesis of idiopathic dystonia remains to be determined.
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Affiliation(s)
- R Benecke
- Neurologische Klinik, Heinrich-Heine-Universität, Düsseldorf, Federal Republic of Germany
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21
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Hirano M, Ricci E, Koenigsberger MR, Defendini R, Pavlakis SG, DeVivo DC, DiMauro S, Rowland LP. Melas: an original case and clinical criteria for diagnosis. Neuromuscul Disord 1992; 2:125-35. [PMID: 1422200 DOI: 10.1016/0960-8966(92)90045-8] [Citation(s) in RCA: 235] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We describe the full history and postmortem findings in one of the first identified cases of mitochondrial encephalomyopathy with stroke-like episodes (MELAS). To clarify diagnostic criteria, we analyzed 69 reported cases. The syndrome should be suspected by the following three invariant criteria: (1) stroke-like episode before age 40 yr; (2) encephalopathy characterized by seizures, dementia, or both; and (3) lactic acidosis, ragged-red fibers (RRF), or both. The diagnosis may be considered secure if there are also at least two of the following: normal early development, recurrent headache, or recurrent vomiting. There are incomplete syndromes in relatives of patients with the full syndrome and incomplete syndromes might also be encountered in sporadic cases. Some MELAS patients have features of the Kearns-Sayre syndrome (KSS) or myoclonic epilepsy with ragged-red fibers (MERRF), but none had the full KSS syndrome. In partial or confusing cases, analysis of mitochondrial DNA (mtDNA) may point to the correct diagnosis; however, not all patients with clinical MELAS have had the typical mtDNA point mutation and some patients with the mutation have clinical syndromes other than MELAS.
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Affiliation(s)
- M Hirano
- Department of Neurology, H. Houston Merritt Clinical Research Center for Muscular Dystrophy and Related Diseases, Columbia-Presbyterian Medical Center, New York, New York
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22
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Shoffner JM, Watts RL, Juncos JL, Torroni A, Wallace DC. Mitochondrial oxidative phosphorylation defects in Parkinson's disease. Ann Neurol 1991; 30:332-9. [PMID: 1952821 DOI: 10.1002/ana.410300304] [Citation(s) in RCA: 247] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Parkinson's disease has been associated with defects in oxidative phosphorylation (Oxphos). We analyzed mitochondria isolated from muscle biopsies of 6 patients with Parkinson's disease for deficiencies in Oxphos enzymes and for mutations in the mitochondrial DNA. Oxphos enzyme assays were compared to the 5 to 95% confidence intervals from 16 control subjects. Four patients had complex I defects, whereas 1 patient had a complex IV defect. A genetic basis for Parkinson's disease was suggested by the presence of affected relatives of 2 patients with Parkinson's disease. Known pathological mitochondrial DNA mutations (insertion-deletions or point mutations) were not found. We conclude that Parkinson's disease is a systemic disorder of Oxphos, probably of a complex genetic etiology. Premature cell death in the nigrostriatal dopamine pathway could be due to energetic impairment and accentuated free radical generation caused by an Oxphos defect.
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Affiliation(s)
- J M Shoffner
- Department of Neurology, Emory University School of Medicine, Atlanta, GA 30322
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23
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Abe K, Fujimura H, Nishikawa Y, Yorifuji S, Mezaki T, Hirono N, Nishitani N, Kameyama M. Marked reduction in CSF lactate and pyruvate levels after CoQ therapy in a patient with mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS). Acta Neurol Scand 1991; 83:356-9. [PMID: 1887756 DOI: 10.1111/j.1600-0404.1991.tb03962.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Many CoQ trials for mitochondrial encephalomyopathy are reported, however, the action of CoQ in the central nervous system is unknown. We administered CoQ to a patient with MELAS, and decreasing CSF lactate and pyruvate levels were revealed. This reduction in CSF lactate and pyruvate may be evidence that CoQ acts directly on the CNS. There have been no other descriptions of evidence of CoQ effective action in the central nervous system, a finding unique to this report.
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Affiliation(s)
- K Abe
- Department of Neurology, Osaka University Medical School, Japan
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24
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Abstract
MELAS syndrome is a distinct clinical entity belonging to a group of mitochondrial encephalomyopathies characterized by the tetrad of myopathy, encephalopathy, lactic acidosis, and stroke-like episodes. Computed tomography (CT) and magnetic resonance (MR) findings are reviewed in a patient with MELAS. Serial CT studies demonstrated multiple "migrating" infarcts in various stages of evolution involving primarily the posterior temporal and occipital regions. MR was more sensitive than CT in demonstrating the number and extent of cortical lesions in this disease entity.
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25
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Morita K, Ono S, Fukunaga M, Yasuda T, Higashi Y, Terao A, Morita R. Increased accumulation of N-isopropyl-p-(123I)-iodoamphetamine in two cases with mitochondrial encephalomyopathy with lactic acidosis and strokelike episodes (MELAS). Neuroradiology 1989; 31:358-61. [PMID: 2636890 DOI: 10.1007/bf00344185] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We present two cases with mitochondrial encephalopathy with lactic acidosis and strokelike episodes (MELAS), which showed both increased and decreased accumulation of N-isopropyl-p-(123I)-iodoamphetamine (123I-IMP) in single photon emission computed tomography (SPECT). The increased accumulation of the tracer occurred, before low density appeared on conventional computed tomography, suggesting that 123I-IMP SPECT may be useful in pathophysiological study of MELAS.
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Affiliation(s)
- K Morita
- Department of Nuclear Medicine, Kawasaki Medical School, Okayama, Japan
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26
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Abstract
Two patients are reported with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes in whom CT documented massive focal brain swelling with midline shift concurrent with exacerbations of their conditions. Brain swelling producing mass effect should be recognized as a feature of MELAS.
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Affiliation(s)
- G N Breningstall
- Department of Pediatric Subspecialties, Park Nicollet Medical Center, Minneapolis, MN 55404
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27
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Maertens P, Richardson R, Bastian F, Williams JP, Hommes F. A new type of mitochondrial encephalomyopathy with stroke-like episodes due to cytochrome oxidase deficiency. J Inherit Metab Dis 1988; 11 Suppl 2:186-8. [PMID: 2846960 DOI: 10.1007/bf01804231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- P Maertens
- Department of Neurology, University of South Alabama, Mobile
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