Mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes (MELAS) syndrome: an autopsy report

Arch Pathol Lab Med. 1998 Nov;122(11):978-81.


Autopsy reports of patients with mitochondrial encephalopathy with lactic acidosis and strokelike episode (MELAS) are rare. This report documents the clinical and autopsy findings of a 47-year-old woman with MELAS syndrome. The diagnosis was corroborated by documenting a mitochondrial DNA mutation tRNA-Leu (UUR) at position 3243. The patient's clinical history was marked by schizophrenia, peptic ulcer disease, constipation requiring hemicolectomy, migraine headaches, deafness, and a left temporal lobe infarct. At autopsy, a muscle biopsy demonstrated numerous ragged red fibers and a partial cytochrome C oxidase deficiency. By electron microscopy, increased numbers of slightly hypertrophic mitochondria were observed focally within myocytes and vessel walls; paracrystalline mitochondrial inclusions were not seen. The brain at autopsy showed mild cerebral atrophy and diffuse cortical gliosis. Prominent bilateral basal ganglia calcifications and vascular sclerosis were present, and a small remote left temporal lobe infarct was seen.

Publication types

  • Case Reports

MeSH terms

  • DNA Mutational Analysis
  • DNA, Mitochondrial / analysis*
  • Electron Transport Complex IV / metabolism
  • Fatal Outcome
  • Female
  • Humans
  • Immunoenzyme Techniques
  • MELAS Syndrome / genetics
  • MELAS Syndrome / metabolism
  • MELAS Syndrome / pathology*
  • Magnetic Resonance Imaging
  • Middle Aged
  • Mitochondria / genetics
  • Mitochondria / ultrastructure
  • Muscle Fibers, Skeletal / ultrastructure
  • Muscle, Skeletal / pathology
  • Point Mutation*


  • DNA, Mitochondrial
  • Electron Transport Complex IV