I had never before had an experience with a
MELAS syndrome patient, although I have experience in treating another fatal mitochondrial disease, amyotrophic bilateral sclerosis, with some relative success but accompanied by the incapacity of the patients to pursue the treatment.
The differential diagnosis includes a host of sporadic and familial conditions associated with strokes, such as coagulopathy (ie, thrombotic thrombocytopenic purpura),
MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes), abnormal lipoproteinemias, cerebral amyloid angiopathy, Fabry disease, and homocystinuria.