A case of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes mimicking migraine attacks with visual aura
10.3760/cma.j.cn431274-20210630-00712
- VernacularTitle:模拟视觉先兆偏头痛发作的MELAS一例
- Author:
Na YUAN
1
;
Min LI
;
Feng XIA
;
Yonghong LIU
Author Information
1. 空军军医大学第一附属医院神经内科，西安 710032
- Keywords:
MELAS syndrome;
Migraine with aura;
Epilepsy, occipital lobe
- From:
Journal of Chinese Physician
2022;24(5):749-752
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To study the case of mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) which mimic migraine attacks with visual aura, to analyze the clinical features, and to recognize the nature of headache.Methods:The clinical features, image data and video electroencephalogram (EEG) of a suspected patient with MELAS were analyzed. Genomic DNA of mitochondria was extracted from blood and the next generation sequencing was performed to explore the mutation of genes about MELAS.Results:The patient was adolescent-onset, and presented with migraine-like attacks with visual aura, epileptic seizures, stroke-like episodes and hyperlactemia. Brain images suggested basal ganglia calcification, reversible left occipital cortex infarction and abnormal lactic acid peaks in both occipital cortex. Video EEG suggested abnormal adolescent EEG. Mitochondrial DNA sequencing showed that MT-TL1 gene had m. 3243A>G pathogenic mutation.Conclusions:There are a variety of clinical manifestations in MELAS, and migraine-like attacks with visual aura as initial symptoms may be manifestations of occipital lobe epilepsy. Clinicians should avoid confusing the diagnosis of migraine with visual aura, occipital epilepsy and MELAS, in order to make rational clinical decisions.
