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These two and nine other reported patients share the following features: ragged red fibers evident on muscle biopsy, normal early development, short stature, seizures, and hemiparesis, hemianopia, or cortical blindness. Lactic acidemia is a common finding. We believe that MELAS represents a distinctive syndrome and that it can be differentiated from two other clinical disorders that also are associated with mitochondrial myopathy and cerebral disease: Kearns\u2010Sayre syndrome and the myoclonus epilepsy ragged red fiber syndrome. Existing information suggests that MELAS is transmitted by maternal inheritance. The ragged red fibers suggest an abnormality of the electron transport system, but the precise biochemical disorders in these three clinical syndromes remain to be elucidated.<\/jats:p>","DOI":"10.1002\/ana.410160409","type":"journal-article","created":{"date-parts":[[2005,1,1]],"date-time":"2005-01-01T17:15:10Z","timestamp":1104599710000},"page":"481-488","source":"Crossref","is-referenced-by-count":972,"title":["Mitochondrial myopathy, encephalopathy, lactic acidosis, and strokelike episodes: A distinctive clinical syndrome"],"prefix":"10.1002","volume":"16","author":[{"given":"Steven G.","family":"Pavlakis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Phillips","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salvatore","family":"DiMauro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darryl C.","family":"De Vivo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis P.","family":"Rowland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2004,10,7]]},"reference":[{"key":"e_1_2_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(72)90070-6"},{"key":"e_1_2_1_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.1978.00500360025005"},{"key":"e_1_2_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(78)90003-5"},{"key":"e_1_2_1_5_2","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-45-6-1281"},{"key":"e_1_2_1_6_2","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410060605"},{"key":"e_1_2_1_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(76)90063-0"},{"key":"e_1_2_1_8_2","first-page":"111","volume-title":"Mitochondrial Pathology in Muscle Diseases","author":"DiMauro S","year":"1983"},{"key":"e_1_2_1_9_2","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.33.1.109"},{"key":"e_1_2_1_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.44.1.79"},{"key":"e_1_2_1_11_2","first-page":"87","volume-title":"Mitochondrial Pathology in Muscle Diseases","author":"Fukuhara N","year":"1983"},{"key":"e_1_2_1_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(80)90031-3"},{"key":"e_1_2_1_13_2","unstructured":"Gardner\u2010MedwinD DaleG ParkinJM: Lactic acidosis with mitochondrial myopathy and recurrent coma (abstract). 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