Volume loss was present in the right middle cerebral artery distribution. A biopsy at this time revealed gliosis. Recently the patient was re-admitted with increasing blurred vision and the presence of flashing lights. The patient subsequently became confused. Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes.
Muscle biopsy demonstrates ragged red fibers.
Biopsy of the brain demonstrates necrosis with reactive astrocytosis thought to represent infarcts. Affected ages from 4 to 46 years of age.