Document Type: Case Report
Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran
Association of Nuclear Medicine and Molecular Imaging (ANMMI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome is a rare congenital disorder of mitochondrial DNA, presenting a wide range of clinical symptoms comprising headaches, seizures, aphasia, hearing loss, visual defects, and hemiparesis. Herein we report a case of a previously asymptomatic 40-year-old male who presented with recurrent headache, seizures, Wernicke’s aphasia, and impaired visual acuity. Investigations included CT, MRI, MR venography, MR spectroscopy, and PET/CT with 18F-fluorodeoxyglucose (18F-FDG-PET) of the brain. PET imaging showed diffuse increased 18F-FDG uptake in the right hemisphere and left temporal lobe; additionally, decreased 18F-FDG uptake was observed in the left frontoparietal lobe. The patient underwent treatment by levetiracetam, co-enzyme Q10, riboflavin, L-carnitine, and lacosamide, followed by improvement of his clinical signs and symptoms indicative of partial response to the therapy.