Clinicoradiologic Criteria for the Diagnosis of Stroke-like Episodes in MELAS.

Journal

Neurology. Genetics
ISSN: 2376-7839
Titre abrégé: Neurol Genet
Pays: United States
ID NLM: 101671068

Informations de publication

Date de publication:
Aug 2023
Historique:
received: 31 10 2022
accepted: 16 05 2023
medline: 10 7 2023
pubmed: 10 7 2023
entrez: 10 7 2023
Statut: epublish

Résumé

Stroke-like episodes (SLEs) in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome are often misdiagnosed as acute ischemic stroke (AIS). We aimed to determine unique clinical and neuroimaging features for SLEs and formulate diagnostic criteria. We retrospectively identified patients with MELAS admitted for SLEs between January 2012 and December 2021. Clinical features and imaging findings were compared with a cohort of patients who presented with AIS and similar lesion topography. A set of criteria was formulated and then tested by a blinded rater to evaluate diagnostic performance. Eleven MELAS patients with 17 SLE and 21 AISs were included. Patients with SLEs were younger (median 45 [37-60] vs 77 [68-82] years, Clinicoradiologic criteria based on simple anamnesis and a CT scan at presentation can accurately diagnose SLE and lead to early administration of appropriate therapy. This study provides Class III evidence that an algorithm using clinical and imaging features can differentiate stroke-like episodes due to MELAS from acute ischemic strokes.

Sections du résumé

Background and Objectives UNASSIGNED
Stroke-like episodes (SLEs) in patients with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome are often misdiagnosed as acute ischemic stroke (AIS). We aimed to determine unique clinical and neuroimaging features for SLEs and formulate diagnostic criteria.
Methods UNASSIGNED
We retrospectively identified patients with MELAS admitted for SLEs between January 2012 and December 2021. Clinical features and imaging findings were compared with a cohort of patients who presented with AIS and similar lesion topography. A set of criteria was formulated and then tested by a blinded rater to evaluate diagnostic performance.
Results UNASSIGNED
Eleven MELAS patients with 17 SLE and 21 AISs were included. Patients with SLEs were younger (median 45 [37-60] vs 77 [68-82] years,
Discussion UNASSIGNED
Clinicoradiologic criteria based on simple anamnesis and a CT scan at presentation can accurately diagnose SLE and lead to early administration of appropriate therapy.
Classification of Evidence UNASSIGNED
This study provides Class III evidence that an algorithm using clinical and imaging features can differentiate stroke-like episodes due to MELAS from acute ischemic strokes.

Identifiants

DOI: 10.1212/NXG.0000000000200082 PMID: 37426458 PMC: PMC10323819
pubmed: 37426458
doi: 10.1212/NXG.0000000000200082
pii: NXG-2023-000024
pmc: PMC10323819
doi:

Types de publication

Journal Article

Langues

eng

Pagination

e200082

Informations de copyright

Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.

Déclaration de conflit d'intérêts

The authors report no relevant disclosures. Go to Neurology.org/NG for full disclosures.

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Auteurs

Vadim Khasminsky (V)

From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN.

Eitan Auriel (E)

From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN.

Judith Luckman (J)

From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN.

Ruth Eliahou (R)

From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN.

Edna Inbar (E)

From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN.

Keshet Pardo (K)

From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN.

Yuval Landau (Y)

From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN.

Rani Barnea (R)

From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN.

Maor Mermelstein (M)

From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN.

Shahar Shelly (S)

From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN.
ORCID: 0000-0002-3585-1687

Jonathan Naftali (J)

From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN.

Shlomi Peretz (S)

From the Departments of Imaging (V.K., J.L., R.E., E.I.) and Neurology (E.A., K.P., R.B., M.M., J.N., S.P.), Rabin Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine (V.K., E.A., J.L., R.E., E.I., Y.L., R.B., S.P.), Tel Aviv University; Metabolic Diseases Clinic (Y.L.), Schneider Children's Medical Center, Petach Tikva; Department of Neurology (S.S.), Rambam Health Care Campus, Haifa, Israel; and Department of Neurology (S.S.), Mayo Clinic, Rochester, MN.

Classifications MeSH