Purpose: This study aimed to develop a scale to measure distress in patients with ischemic stroke and verify its validity and reliability. Methods: Preliminary items were developed from literature review and in-depth interviews. The final preliminary scale was confirmed through a content validity test of eight experts and a preliminary survey of 10 stroke patients. The participants for psychometric testing were 305 stroke patients in the outpatient clinic. Validity and reliability analyses included item analysis, exploratory and confirmatory factor analysis, convergent validity, known-group validity, and internal consistency of the scale. Results: The final scale consisted of 17 items and 3 factors. The three distinct factors were ‘self-deprecation, worry about future health, and withdrawal from society’ and this structure was validated using a confirmatory factor analysis. Convergent validity was supported by comparison with the Center for Epidemiologic Studies Depression Scale (r = .54, p < .001) and Brief Illness Perception Questionnaire (r = .67, p < .001). Known-groups validity was verified by dividing groups according to ‘duration since diagnosis’ (t = 2.65, p = .009), ‘presence of sequela’ (t = 10.16, p < .001), and ‘awareness of distress’ (t = 12.09, p < .001). The internal consistency of the scale using Cronbach’s α for the total items was .93. Conclusion The Ischemic Stroke Distress Scale is a valid and reliable tool that reflects stroke distress effectively. It is expected to be used as a basic tool to develop various intervention strategies to reduce distress in ischemic stroke patients.

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episode (MELAS) syndrome is a maternally inherited mitochondrial disorder that usually affects the cerebral cortex and prevents high-energy demands from being met. Herein, we present the case of a male patient who rapidly developed multiple seizures, headaches, and altered mentality accompanied by severe metabolic acidosis and lactic acidosis. Initially, a brain imaging study confirmed stroke-like lesions (SLLs) only in the cerebellum. During follow-up, newly developed SLLs with lactic acidosis were observed in the basal ganglia (BG), cerebellum, and occipital lobe. The m.3243A>G variant had been found in the patient and MELAS was diagnosed, despite the BG and cerebellum being atypical locations for SLLs in MELAS. Since most cases of m.3243A>G variant MELAS show SLLs in the cerebral cortex, this case is unusual considering the location of the lesion. We emphasize that in the case of lactic acidosis accompanied by neurological symptoms, such as seizures, as in this case, MELAS should be included in the differential diagnosis, even if SLLs are observed in areas other than the cerebral cortex.