Epileptic vertigo in MELAS syndrome

Abstract

Background & Significance : Epileptic seizure is a frequent sign of mitochondrial encephalopathies with lactic acidosis and stroke-like episodes (MELAS). But, epileptic seizure rarely caused only vertiginous symptom. We report a case of MELAS syndrome with epileptic seizure showing only vertigo symptom. Case : A 34-year-old women was admitted to our hospital with confusion, left homonymous hemianopsia and seizure like motion. B rain magnetic resonance imaging revealed high signal intensity at left occipital area. After evaluation of stroke etiology, we diagnosed as isolated CNS vasculitis. But, during hospital days, she showed epileptic vertigo with vomiting and mild muscle weakness. To rule out MELAS syndrome, muscle biopsy was done. And, myofiber with atrophic change and ragged red fiber was found in biopsy. Finally, she was diagnosed as MELAS syndrome. But, during hospital days, she showed vertiginous symptom with downbeat nystagmus and it was subsided by IV diazepam. EEG showed sharp waves at both temporal areas.