MELAS stroke-like episodes (SLEs): radiological features

Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .

MELAS stroke-like episodes (SLEs): radiological features. There are focal or multifocal lesions. Fully referenced neurology checklist.

Features of stroke like lesions

  • There are focal or multifocal lesions
  • These may be cortical or subcortical
  • They may be symmetrical
  • They are dynamic
  • They progressively expand over days to months
  • They do not conform to vascular territories
  • They appear as cytotoxic oedema and progress to vasogenic oedema
  • They manifest as hyper-perfusion on perfusion studies

Radiological patterns

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Radiological outcomes

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Differential diagnosis

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Distinguishing features from ischaemic stroke

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Acronym

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References

  1. Finsterer J, Aliyev R. Metabolic stroke or stroke-like lesion: peculiarities of a phenomenon. J Neurol Sci 2020; 412:116726. 
  2. Finsterer J. Mitochondrial metabolic stroke: phenotype and genetics of stroke-like episodes. J Neurol Sci 2019; 400:135-141.
  3. Finsterer J. Therapeutic management of stroke-like episodes varies from that of encephalitis. Medicine (Baltimore) 2020; 99:e19141. 
  4. Martinez-Fernandez E, Gil-Peralta A, Garcia-Lozano R, et al. Mitochondrial disease and stroke. Stroke 2001; 32:2507-2510.
  5. Durrleman C, Grevent D, Aubart M, et al. Clinical and radiological description of 120 pediatric stroke-like episodes. Eur J Neurol 2023; 30:2051-2061.
  6. And 7 more. Subscribe to see the full list

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