We report the case of a 21-years-old man affected by fluctuating stroke-like symptoms and computed-tomographic hypodensities, associated with seizures, headache, vomiting and a biochemically abnormal response of blood lactate and pyruvate after an oral glucose load. Muscle biopsy showed an increased number of subsarcolemmal mitochondria of increased size. Mitochondrial enzyme analysis was normal. The diagnosis of a MELAS-like mitochondrial disease even with minor muscle involvement is discussed.
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