The precise mechanism of neurological symptoms in patients with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) is still controversial. The diVusion weighted MR findings at the acute phase of a neurological event in MELAS are described and the pathophysiology of stroke-like lesion in the light of diVusion changes is discussed. Brain MRI was performed 2 days after the sudden onset of cortical blindness in a 25 year old patient with MELAS. Fluid attenuated inversion recovery (FLAIR) images showed multifocal cortical and subcortical hyperintensities located bilaterally in the frontobasal and the temporooccipital lobes. DiVusion weighted images showed normal to increased apparent diffusion coeYcient values in the acute left temporooccipital lesion and increased values in the older stroke-like lesions. These diVusion weighted findings support the metabolic rather than the ischaemic pathophysiological hypothesis for strokelike episodes occurring in MELAS. Normal or increased apparent diVusion coeYcient values within 48 hours of a neurological deficit of abrupt onset should raise the possibility of MELAS, especially if conventional MR images show infarctlike lesions. (J Neurol Neurosurg Psychiatry 2000;69:248-250)
We describe a young man with Behçet's disease who presented with acute coronary insufficiency: emergency coronary arteriography revealed 2 coronary aneurysms and a left anterior descending (LAD) artery stenosis which was successfully dilated. The reduction of the coronary stenosis by balloon angioplasty induced immediate relief of chest pain and decrease of ST segment elevation, and was probably responsible for the satisfactory evolution, with limited myocardial infarction on the ECG and no akinetic segment on the left ventricular angiogram 3 weeks after the acute event. Cardiac surgery was performed to avoid possible relapse or aneurysmal rupture with hemopericardium. Surgery confirmed the destructive arterial lesion of Behçet's disease with false aneurysms of the LAD and left circumflex arteries.
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