Imaging in Sequential Stroke-like Episodes in Adult MELAS

Sequential Stroke-Like Lesions in MELAS are Common and Diagnosable upon Multimodal MRI

“…With interest we read the article by Chen et al about a 53-year-old female with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome who experienced two sequential stroke-like episodes (SLEs) within 12 months. 1 It was concluded that MELAS can mimic stroke in older patients, but is distinguished on MRI and with appropriate clinical suspicion, why unnecessary biopsy can be avoided. 1 We have the following comments and concerns.…”

“…1 It was concluded that MELAS can mimic stroke in older patients, but is distinguished on MRI and with appropriate clinical suspicion, why unnecessary biopsy can be avoided. 1 We have the following comments and concerns.…”

“…2 We do not agree with the wording in the title. 1 Imaging is not carried out of SLEs but of stroke-like lesions (SLLs), the morphological equivalent of an SLE on imaging.…”

“…We do not agree with the statement that MELAS is only an inherited disorder. 1 MELAS is inherited in only about 75% of the cases. 3 In the remainder, the causative mutation occurs spontaneously.…”

“…We do not agree that "SLEs occur with cortical imaging abnormalities". 1 The authors obviously mean SLLs, which usually start in the cortex and usually spread to the subcortical white matter and the deep grey matter. 4 Furthermore, SLLs not only occur supratentorially but also infratentorially.…”