Stroke-like lesions in mitochondrial disease may resemble ischemic stroke

The patient is a 73-y-male who was referred after a fall without losing consciousness or secessus. Clinical exam revealed disorientation, ophthalmoparesis, hemianopia to the left, left hemineglect, hypoacusis, quadruparesis, general wasting, generally reduced tendon reflexes, mild rigor, occasional myoclonic jerks of the right lower limb, and ataxia of the left lower limb. Cerebral magnetic resonance imaging (MRI) showed a stroke-like lesion (SLL), generalized atrophy, white matter lesions, and ponsgliosis. The previous history was positive for diabetes, hypoacusis, arterial hypertension, hyperlipidemia, vitamin-D deficiency, cataract, esophageal adenocarcinoma, histiocytoma, Barrett esophagus, hiatal hernia, colonic polyps, and lactic acidosis. Based upon this phenotypic spectrum, lactic acidosis, and the cerebral MRI, a mitochondrial disorder (MID) was diagnosed. This case shows that a MID may be missed for years, that an SLL may be easily mixed up with ischemic stroke; and that the initial manifestation of an SLL may be a fall.