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Diffusion-weighted MR Imaging in a Case of Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis, and Strokelike Episodes

Kiminobu YonemuraGo,a, Yasuhiro Hasegawaa, Kazumi Kimuraa, Kazuo Minematsua and Takenori Yamaguchia

a From the Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, Osaka, Japan.



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  		FIG 1. A, Axial T2-weighted image obtained at the time of initial hospitalization (8 days after the onset of symptoms).

B, Contrast-enhanced T1-weighted image reveals small hyperintense lesions with patchy and punctate enhancement in the bilateral occipital cortices.

C and D, Follow-up images obtained 2 months later show resolution of the lesions.



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  		FIG 2. A, Axial T2-weighted image obtained at the time of the second hospitalization (2 days after the onset of symptoms).

B, Diffusion-weighted image shows an extensive hyperintense lesion involving the cortex and subcortical white matter in the left occipital lobe.

C, Corresponding ADC map reveals no obvious abnormalities.

D, 99mTc-HMPAO SPECT scan obtained on day 3 shows a remarkable increase in tracer accumulation in the left occipital lobe. Follow-up images obtained 2 weeks later (not shown) indicated the resolution of the left occipital abnormality with residual localized atrophy.



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  		FIG 3. A, Axial T2-weighted image obtained at the time of the third hospitalization (2 days after the onset of symptoms).

B, Diffusion-weighted image reveals a cortical hyperintense lesion in the right occipital lobe.

C, 99mTc-HMPAO SPECT scan obtained on the same day shows a remarkable increase in tracer accumulation in the right occipital cortex. Follow-up MR images obtained 2 weeks later (not shown) revealed resolution of the right occipital abnormality, and SPECT scans obtained 16 days after the onset of symptoms (not shown) showed a normal accumulation in the right occipital cortex.





Copyright © 2008 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X