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Published on: July 28, 2018
Cerebral vasodilation and lesion patterns in stroke-like episodes of MELAS: a quantitative angiographic investigation
Kwanju Song1, Myung Ki Yoon1, Wookjin Yang1
1Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Background:
The pathophysiology of stroke-like episodes in mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome remains incompletely understood, despite the syndrome's distinctive clinical and radiological characteristics. This study aimed to gain insight into the underlying mechanisms of stroke-like episodes by analyzing vascular and perfusion changes during acute stroke-like episodes.
Methods:
We conducted a retrospective observational study of genetically confirmed MELAS patients who experienced stroke-like episodes between January 2010 and December 2023. All patients underwent magnetic resonance imaging (MRI) and angiography during the acute phase. Vessel diameters were quantitatively measured at predefined anatomical locations on both the affected and contralateral sides, and were compared using the Wilcoxon signed-rank test. Follow-up imaging was reviewed when available to assess the reversibility of vascular changes.
Results:
Among the 17 patients, 15 (88.2%) exhibited lesions characterized by cortical cytotoxic edema and subcortical vasogenic edema. Angiographic analysis revealed significant vasodilation of major vessels in 10 patients (58.8%), primarily affecting the middle cerebral artery (MCA) on the symptomatic side. Hyperperfusion was observed in all patients who underwent perfusion-weighted MRI, which spatially corresponded to stroke-like lesions. Quantitative analysis indicated a significant difference in vessel diameter between the affected [1.92 (interquartile range, 1.76-2.42)] and unaffected sides [1.84 (interquartile range, 1.74-2.22), Z=-2.250, P=0.024]. Follow-up angiography was conducted for three patients, all of whom demonstrated complete resolution of vasodilation.
Conclusions:
Our findings of cortical cytotoxic edema, subcortical vasogenic edema, and reversible major vessel vasodilation during stroke-like episodes contribute to the pathophysiological understanding of MELAS based on mitochondrial energy failure.
Insights
Stroke-like episodes in MELAS patients show vasodilation and hyperperfusion. These vascular changes, including reversible middle cerebral artery vasodilation, are linked to mitochondrial energy failure.
Area of Science:
- Neurology
- Mitochondrial Diseases
- Vascular Imaging
Background:
- Pathophysiology of stroke-like episodes in MELAS syndrome is not fully understood.
- Distinctive clinical and radiological features of MELAS syndrome are known.
- This study investigates vascular and perfusion changes during acute stroke-like episodes in MELAS.
Purpose of the Study:
- To elucidate the mechanisms of stroke-like episodes in MELAS.
- To analyze vascular and perfusion alterations during acute MELAS events.
- To correlate imaging findings with underlying mitochondrial dysfunction.
Main Methods:
- Retrospective observational study of genetically confirmed MELAS patients.
- Analysis of MRI and angiography during acute stroke-like episodes (2010-2023).
- Quantitative measurement and comparison of vessel diameters; assessment of perfusion and reversibility.
Main Results:
- 15/17 patients had cortical cytotoxic and subcortical vasogenic edema.
- Significant vasodilation of major vessels, particularly MCA, observed in 10/17 patients.
- Hyperperfusion detected in all patients, spatially correlating with lesions; reversible vasodilation confirmed on follow-up.
Conclusions:
- Cortical cytotoxic edema, subcortical vasogenic edema, and reversible vasodilation are key features of MELAS stroke-like episodes.
- Findings support a pathophysiology linked to mitochondrial energy failure.
- Reversible vascular changes offer potential therapeutic targets in MELAS.
