Case 298

 A 4-year-old girl was transported to our hospital by ambulance for convulsion and loss of consciousness. Immediately after initiation of lunch in kinder garden, she dropped sliding down from a chair with face redness and tonic convulsion lasting for around 10 minutes. Laboratory test revealed AST 48 U/l, ALT 28 U/l, ALP 542 U/l and lactic acid 48 mg/dL.
 She experienced convulsion previously two years ago. She had been admitted in our hospital several times not just for convulsion but for consciousness disorder, hypo-glucosemia, and hyper-lactic acidemia. She took brain CT and MRI for further investigation (Figs. 1-3).

What is a possible imaging diagnosis?

1.　Hypoglycemic encephalopathy

2.　Leigh syndrome

3.　Creutzfeldt-Jakob disease

4.　MELAS syndrome

5.　Wilson disease

answer

2023.5.12