{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T21:19:33Z","timestamp":1783113573121,"version":"3.54.6"},"reference-count":12,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T00:00:00Z","timestamp":1710288000000},"content-version":"vor","delay-in-days":12,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,3,1]],"date-time":"2024-03-01T00:00:00Z","timestamp":1709251200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:sec>\n                    <jats:title>Key Clinical Message<\/jats:title>\n                    <jats:p>MELAS is a disorder with clinical variability that also responsible for a significant portion of unexplained hereditary or childhood\u2010onset hearing loss. Although patients typically present in childhood, the first stroke\u2010like episode can occur later in life in some patients, potentially related to a lower heteroplasmy level. It is crucial to consider MELAS as a potential cause of stroke\u2010like events if age at presentation and symptoms are atypical, especially among middle\u2010aged patients without vascular risk factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>\n                      MELAS syndrome (mitochondrial encephalopathy with lactic acidosis and stroke\u2010like episodes) is a rare genetic condition that most patients develop stroke\u2010like episodes before the age of 40. We report a 52\u2010year\u2010old female with a documented 40\u2010year history of progressive sensorineural hearing loss, developed a visual field deficit and stroke\u2010like events in her middle age who finally diagnosed was MELAS. The patient was started on vitamin E,\n                      <jats:sc>l<\/jats:sc>\n                      \u2010carnitine,\n                      <jats:sc>l<\/jats:sc>\n                      \u2010arginine, and coenzyme Q10 that gradually improved before dismissal from the hospital. This case highlights the importance of considering MELAS as a potential cause of stroke\u2010like events if imaging findings are atypical for cerebral infarction, especially among middle\u2010aged patients without vascular risk factors and an unusual cause of progressive sensorineural hearing loss.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ccr3.8438","type":"journal-article","created":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T23:42:50Z","timestamp":1710373370000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Elderly onset of\n                    <scp>MELAS<\/scp>\n                    carried an M.\n                    <scp>3243A<\/scp>\n                    \u2009&gt;G mutation in a female with deafness and visual deficits: A case report"],"prefix":"10.1002","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5409-5004","authenticated-orcid":false,"given":"Lin","family":"Zijun","sequence":"first","affiliation":[{"name":"Department of Neurology Army Medical Center of People's Liberation Army of China  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Neurology Army Medical Center of People's Liberation Army of China  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Yujia","sequence":"additional","affiliation":[{"name":"Department of Neurology Army Medical Center of People's Liberation Army of China  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xu","family":"Zhiqiang","sequence":"additional","affiliation":[{"name":"Department of Neurology Army Medical Center of People's Liberation Army of China  Chongqing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,3,13]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/ana.410160409"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1293.022"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ymgme.2015.06.004"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/mus.20807"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bbagen.2011.03.015"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1136\/practneurol-2014-000853"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1080\/08990220.2020.1720636"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415-020-10390-9"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.3174\/ajnr.A6325"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/postgradmedj-2011-130326"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.4103\/0974-9233.51998"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2016.04.024"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.8438","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.8438","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.8438","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T20:39:58Z","timestamp":1783111198000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.8438"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3]]},"references-count":12,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1002\/ccr3.8438"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.8438","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3]]},"assertion":[{"value":"2023-08-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e8438"}}