Therapeutic management of stroke-like episodes varies from that of encephalitis

Area of Science:

• Neurology
• Mitochondrial Medicine
• Neuroimaging

Background:

• Stroke-like episodes (SLEs) are characteristic cerebral manifestations of mitochondrial disorders (MIDs).
• These episodes manifest as stroke-like lesions (SLLs) on cerebral MRI, defined by vasogenic edema in non-vascular distributions.
• SLLs exhibit dynamic changes, expanding in the acute phase and regressing in the chronic phase, with altered perfusion patterns.

Observation:

• SLLs exhibit dynamic changes, expanding in the acute phase and regressing in the chronic phase.
• Acute SLLs show hyperperfusion, while chronic SLLs demonstrate hypoperfusion on imaging.
• These lesions can evolve into various outcomes, including normal tissue, white or grey matter lesions, cysts, or laminar cortical necrosis.

Findings:

• SLLs are a common manifestation of MIDs.
• Treatment interventions such as antiseizure drugs, steroids, ketogenic diet, and antioxidants show favorable responses.
• Distinguishing SLLs from ischemic stroke is critical for appropriate management.

Implications:

• Understanding the distinct nature of SLLs in MIDs is essential for accurate diagnosis and treatment.
• The dynamic nature and varied outcomes of SLLs necessitate tailored therapeutic strategies.
• This research highlights the importance of neuroimaging in identifying and monitoring SLLs in mitochondrial disease patients.