Familial mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episode syndrome: Three case reports

Figure 1 Magnetic resonance imaging findings of case 1. A: Axial plane magnetic resonance (MR) T1-weighted images showed low signal intensity of the lesion; B: Axial plane MR T2-weighted images showed high signal intensity of the lesion; C: Axial plane MR-fluid-attenuated inversion recovery sequence showed high signal intensity of the lesion; D: Axial plane MR-diffusion-weighted imaging showed a lace-like high signal intensity in the lesion.

Figure 2 Magnetic resonance imaging findings of case 2. A: Coronal magnetic resonance (MR) T1-weighted imaging showed low signal intensity of bilateral frontal lobe lesions; B: Coronal MR T1-weighted imaging showed low signal intensity of the bilateral temporal lobe, parietal lobe, and insular lesions; C: Axial plane MR T2-weighted images showed high signal intensity of the lesion; D: Axial plane MR-fluid-attenuated inversion recovery sequence showed high signal intensity of the lesion; E: Axial plane MR-diffusion-weighted imaging showed lace-like high signal intensity in the lesion.

Figure 3 Magnetic resonance imaging findings of case 3. A: Axial plane magnetic resonance (MR) T1-weighted images showed low signal intensity of the lesion; B: Axial plane MR T2-weighted images showed high signal intensity of the lesion; C: Axial plane MR-fluid-attenuated inversion recovery sequence showed high signal intensity of the lesion; D: Axial plane MR-diffusion-weighted imaging showed lace-like high signal intensity in the lesion; E: Axial plane enhanced T1-weighted MR imaging showed mild enhancement of the lesion.

Figure 4 Muscle pathology images of case 1. A: Modified gomori trichromatic staining showed red fiber breakage; B: Succinate dehydrogenase staining showed blue-stained fiber breakage and hyperstained small vessels (magnification: 200 ×).

Figure 5 Muscle pathology images of case 3. A: Modified gomori trichromatic staining showed red fiber breakage; B: Succinate dehydrogenase staining showed blue-stained fiber breakage and hyperstained small vessels; C: Cytochrome c oxidase (COX) staining showed COX-negative fibers (magnification: 200 ×).