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. 2022 Feb 9;13:843386. doi: 10.3389/fneur.2022.843386

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Copyright © 2022 Cheng, Zhang and He.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Neuroimaging for an 8-year-old girl with MELAS who presented with intermittent fever, vomiting, convulsions. (A,B) Axial T2WI and T2FLAIR imaging reveal multiple hyperintensities in bilateral frontal and parietal cortex and subcortical white matter, especially in the left side; (C) Axial post-contrast T1WI imaging reveals linear enhancement of the left lesions; (D) T2FLAIR image 3 years later demonstrates new migrating lesions of both cerebral hemispheres along with old lesions, accompanied by evolving encephalomalacia, atrophy; (E) DWI imaging demonstrates hyperintensities in gyriform pattern in the lesion areas; (F) ADC sequence shows iso/hyperintensities corresponding to DWI lesions; (G) MRS imaging shows decreased NAA/Cho ratio and a large lactate peak.