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A 52-year-old womanwith a history of a hearing disturbance since age 20 experienced visual hallucinations and convulsions, followed by right hemiparesis and aphasia. On the basis ofa muscle biopsy and mitochondrial DNAanalysis, she was diagnosed as mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS).This case is unique in that the strokelike episodes occurred 30 years after disease onset. (Internal Medicine 35: 991-995, 1996)

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