VII. Other Less Commonly Observed Changes Slide

VII. Other Less Commonly Observed Changes

Fig 16. 12 yr old with visual disturbance. A. Axial DWI demonstrates an area of restricted diffusion in the right occipital lobe. The appearance is consistent with acute ischemia and is non-specific at this time. The patient developed similar symptoms approximately 10 days later. B. Axial DWI performed during this second episode reveals reversal of restricted diffusion in the right occiptal lobe and development of acute ischemia in the left occipital lobe. This pattern is typical for MELAS.

A.	B.	C.
Fig 17. 22 month old male with respiratory difficulties, progressive weakness and balance problems. A. Axial FLAIR image shows abnormal signal in the periaqueductal grey and optic chiasm/tracts (arrow). B. Sagittal T2 FSE of the thoracic cord shows an extensive area of abnormal signal primarily involving the central grey. C. Single voxel long TE MRS performed over the brainstem reveals an abnormal lactate doublet. The findings are very suggestive of mitochondrial OXPHOS disease. The cord involvement in unusual and by itself would raise the differential of MS or ADEM. The abnormal MRS and periaqueductal grey involvement are indicative of a metabolic disorder. Optic tract involvement such as this can be seen with mitochondrial OXPHOS abnormalities.