Neuroimaging: MELAS: practice question

A Radiology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Radiology · Neuroimaging: MELAS

Sample item

A young adult with short stature, hearing loss and lactic acidosis has recurrent stroke-like episodes. MRI shows posterior cortical lesions that do not follow an arterial territory, and spectroscopy shows a lactate peak. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. MELAS

Mitochondrial encephalopathy, lactic acidosis and stroke-like episodes causes cortical lesions in the posterior temporal, parietal and occipital regions that cross vascular territories and may change over time. A lactate peak on spectroscopy supports it. Embolic strokes follow vessels, and CADASIL affects white matter.

Option by option

  • A. Cardioembolic stroke from endocarditis

    Embolic strokes follow arterial territories and lack a lactate peak.

  • B. Herpes simplex encephalitis

    Herpes encephalitis involves the medial temporal lobes and insula.

  • C. CADASIL

    CADASIL involves white matter, especially the anterior temporal poles and external capsule.

  • D. MELAS (correct)

    Correct. Non-territorial posterior cortical lesions with lactate suggest MELAS.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Radiology question

What is the answer to this Radiology question?

The best answer is D, MELAS. Mitochondrial encephalopathy, lactic acidosis and stroke-like episodes causes cortical lesions in the posterior temporal, parietal and occipital regions that cross vascular territories and may change over time.

Why is "Cardioembolic stroke from endocarditis" not the answer?

Embolic strokes follow arterial territories and lack a lactate peak.

Why is "Herpes simplex encephalitis" not the answer?

Herpes encephalitis involves the medial temporal lobes and insula.

Why is "CADASIL" not the answer?

CADASIL involves white matter, especially the anterior temporal poles and external capsule.

What concept does this question test?

It tests Neuroimaging: MELAS in Radiology. A lactate peak on spectroscopy supports it. Embolic strokes follow vessels, and CADASIL affects white matter.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuroimaging: MELAS?

Learn signs with the image, and the disease they point to. Then use the flashcards and the other Radiology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.