Patent foramen ovale leading to mismanagement in a mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke‐like episodes patient

Abstract

The stroke-like episodes and brain MRI lesions in MELAS usually have a nonischemic pattern, are resolved over time, and have a migrating pattern that helps us distinguish them from ischemic cerebral infarcts. Nevertheless, conditions such as intracardiac thromboses, PFO, and hypercoagulable state may be present concomitantly, leading to mismanagement. Therefore, further investigation and echocardiography are suggested in MELAS patients.

Stroke‐like lesions should not be mixed up with ischemic stroke in MELAS with cardioembolic risk

“…We read with interest the article by Salari et al on a 34‐year‐old male with mitochondrial encephalopathy, lactic acidosis, and stroke‐like episode (MELAS) syndrome who had reportedly suffered from recurrent, ischemic, cardioembolic strokes. 1 The patient presented phenotypically with cognitive decline, epilepsy, “stroke,” myopathy, and lactic acidosis. 1 During the clarification of the ischemic strokes, a patent foramen ovale (PFO) and thrombi in the left atrial appendage (LAA) were found.…”

“… 1 The patient presented phenotypically with cognitive decline, epilepsy, “stroke,” myopathy, and lactic acidosis. 1 During the clarification of the ischemic strokes, a patent foramen ovale (PFO) and thrombi in the left atrial appendage (LAA) were found. 1 It was concluded that the index patient is the first with MELAS and a PFO and the first with a progressive pattern of ischemic lesions.…”

“… 1 During the clarification of the ischemic strokes, a patent foramen ovale (PFO) and thrombi in the left atrial appendage (LAA) were found. 1 It was concluded that the index patient is the first with MELAS and a PFO and the first with a progressive pattern of ischemic lesions. 1 The study is excellent but has limitations that should be discussed.…”

“… 1 It was concluded that the index patient is the first with MELAS and a PFO and the first with a progressive pattern of ischemic lesions. 1 The study is excellent but has limitations that should be discussed.…”

“…The major limitation of the study is that the MELAS diagnosis was not genetically confirmed. 1 Although the patient had manifestations of mitochondrial disorder (MID), presented cerebral lactic acidosis and a muscle biopsy showing ragged‐red fibers (abnormal mitochondrial on Gomori trichrome stain), 1 detecting a causative mutation would strongly support the diagnosis. Knowledge of the genetic cause is also crucial for assessing the patient's course and outcome and for genetic counseling.…”