Findings of 123I-Iomazenil SPECT During and After Stroke-Like Episodes in a Patient With MELAS

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Reduced cortical benzodiazepine receptor binding potential in late images of 123I-iomazenil SPECT indicates neuronal damage in the cortex. We present the case of a 31-year-old woman with mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) who had focal seizures in the right hand. FLAIR imaging in the ictal state revealed a high-intensity lesion in the left post-central gyrus, while 123I-iomazenil SPECT showed decreased tracer uptake in this lesion. The lesion completely disappeared on FLAIR imaging performed 1 month after the focal seizures; in contrast, 123I-iomazenil SPECT still revealed a significant decrease in tracer uptake in this lesion.

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