Elderly Onset Male MELAS: A Case Report

Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS) is the most common mitochondrial disease. MELAS in the elderly onset is rarely seen. We herein describe the case of a 61-year-old male MELAS patient. He had experienced acute migraine-like headaches as the first symptoms. Laboratory data showed elevated lactate and creatine kinase levels. Brain MRI showed a high signal intensity lesion in the left occipital-temporal-parietal lobe on diffusion-weighted imaging (DWI). MR angiography revealed reversible vasoconstriction of the middle cerebral arteries and bilateral superficial temporal arteries. Muscle biopsy suggests minor muscle damage. A genetic study revealed a mitochondrial DNA A3243G point mutation. Ischemic cerebrovascular disease is a high incidence in the elderly. Elderly patients with high signal intensity on brain DWI are easily misdiagnosed as ischemic stroke. MELAS should be considered in elderly stroke-like attack patients with multi-lobe DWI high signal without corresponding responsible cerebrovascular disease. MELAS can be preliminarily considered according to MRA, DWI, muscle enzyme, and lactic acid. Suspected patients can be diagnosed with MELAS by muscle biopsy and/or gene detection. Reversible dilation of bilateral superficial temporal arteries supports mitochondrial dysfunction as one of the pathogenesis of migraine.