Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episode with m.3243A>G variant involving the cerebellum and basal ganglia

Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episode (MELAS) syndrome is a maternally inherited mitochondrial disorder that usually affects the cerebral cortex and prevents high-energy demands from being met. Herein, we present the case of a male patient who rapidly developed multiple seizures, headaches, and altered mentality accompanied by severe metabolic acidosis and lactic acidosis. Initially, a brain imaging study confirmed stroke-like lesions (SLLs) only in the cerebellum. During follow-up, newly developed SLLs with lactic acidosis were observed in the basal ganglia (BG), cerebellum, and occipital lobe. The m.3243A>G variant had been found in the patient and MELAS was diagnosed, despite the BG and cerebellum being atypical locations for SLLs in MELAS. Since most cases of m.3243A>G variant MELAS show SLLs in the cerebral cortex, this case is unusual considering the location of the lesion. We emphasize that in the case of lactic acidosis accompanied by neurological symptoms, such as seizures, as in this case, MELAS should be included in the differential diagnosis, even if SLLs are observed in areas other than the cerebral cortex.

Factors predicting meaningful suicide attempts: multiple attempts and index methods

Purpose@#This study investigated the association of the index method, defined as the method used in the first suicide attempt (SA), with the outcome of SAs among adolescents. @*Methods@#The study analyzed medical records of 227 adolescents aged 10-18 years with clear SAs who visited the emergency department of Severance Hospital in Seoul, Korea from January 2007 through February 2021, focusing on the index methods and meaningful SAs defined as hospitalization, death or transfer to another hospital for psychiatric hospitalization. The association of the index method with the meaningful SAs was quantified using logistic regression. @*Results@#Among the 227 adolescents, 80 underwent the meaningful SAs (35.2%). The adolescents with the meaningful SA chose drug intoxication, fall, and hanging as the index methods more frequently than those without the outcome, whereas they showed a reverse pattern in cutting (P < 0.001). The association of fall or cutting with the meaningful SAs remained significant after adjustment (fall: adjusted odds ratio, 6.93 [95% confidence interval, 1.70-28.26]; cutting: 0.39 [0.17-0.91]; compared with those undergoing drug intoxication). Multiple SAs were also associated with the meaningful SA (1.76 [1.04-3.13]). @*Conclusion@#This study identifies the index method and multiple SAs as factors associated with the meaningful SA among adolescents in the emergency department. This finding may be helpful in interviewing adolescents with SAs.