Diffusion-weighted image and MR spectroscopic analysis of a case of MELAS with repeated attacks.

H. S. Kim, D. I. Kim, B. I. Lee, E. K. Jeong, C. Choi, J. D. Lee, P. H. Yoon, E. J. Kim, S. H. Kim, Y. K. Yoon

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25 Citations (Scopus)


We report the clinical and MR manifestations of an 18 year-old girl with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome. Recurrent status epilepticus caused reversible cytotoxic edema on diffusion-weighted images (DWI). Initial and one month follow-up MR spectroscopy, after seizure control, showed some discrepancies in the ratio of metabolites. N-acetylaspartate (NAA) partially recovered (NAA/creatine (Cr) ratio: 1.27-->1.84). This was because of a normalization of decreased NAA due to cellular dysfunction as a result of status epilepticus. A low ratio of NAA/Cr due to abnormal mitochondria remained in the decreased state. Reversible NAA/Cr ratios in the acute lesion suggested that NAA reflects the neuronal function as well as the level of neuronal structural damage. The altered NAA/Cr ratio better correlated with the abnormal signal intensity area of T2-weighted images (T2WI) and DWI than the lactate (Lac)/Cr ratio. With conservative treatment with anti-epileptics not accompanied by coenzyme Q or sodium dichloroacetate, lactate persistently increased (Lac/Cr ratio: 1.01-->1.21) because of the continued production of lactate in cells with respiratory deficiency, which is the main pathology of MELAS.

Original languageEnglish
Pages (from-to)128-133
Number of pages6
JournalYonsei medical journal
Issue number1
Publication statusPublished - 2001 Feb

All Science Journal Classification (ASJC) codes

  • Medicine(all)


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