MELAS Missed for Years: Stroke-Like Lesions Are No Indication for Brain Biopsy

Table 1

Disease trajectory of the presented patient.

Onset, age	Manifestation	Therapy
16 y	Collapse with TBI (petrous bone fracture)	Conservative
23 y	Right bimalleolar fracture	Np
Until 38 y	Chronic alcoholism	Withdrawal
39 y	Icterus, hepatopathy	None
43 y	Small breasts	Breast silicon implants
45–46 y	Relapse of alcoholism	Successful withdrawal
46 y	Epilepsy with focal and generalized seizures	Levetiracetam
46 y	1 SLL with intralesional bleeding (right occipital) hemianopia and neglect to the left, psychosis	Neuroleptics
46 y	Hepatopathy, steatosis hepatis	None
Until age 46 y	Smoking	Withdrawal
46 y	Acne rosacea	Topic ointments
46 y	Arachnoidal cyst (left temporo-basal)	None
46 y	Folic acid deficiency	Folic acid
46 y	Hyperlipidemia	Diet
46 y	2 SLE (left occipital (epilepsy, psychosis, cortical blindness, and optic hallucinations))	Brain biopsy via drill-hole quetiapin
47 y	Arterial hypertension	Bisoprolol
47 y	AV-block-1	None
47 y	Hyponatremia after adding OXC	OXC replaced with CBZ
Since age 47 y	Thrombocytopenia after adding CBZ	CBZ withdrawal
47 y	Myoclonic seizure	Levetiracetam
49 y	Glaucoma	Latanoprost
Until 49 y	Recurrent syncopes due to sinus arrests	Pacemaker
49 y	Hyperthyroidism	None
53 y	Capsular fibrosis	Replacement of breast implants
53 y	Ischemic strokes (PCAS territory, PCAS stenosis)	Antithrombotics
56 y	Barrett esophagus	Esomeprazole
56 y	Hyperostosis frontalis	None
56 y	Generalized brain atrophy	None
Since years	Carpopedal spasms	Magnesium
Since years	Hypoacusis	None

PCAS: left posterior cerebral artery syndrome, PRES: posterior reversible encephalopathy syndrome, SLE: stroke-like episode, AEDs: antiepileptic drugs, SSS: sick-sinus syndrome, TBI: traumatic brain injury, CBZ: carbamazepine, and np: not provided.