unilateral cortical thickening and hyper-intensity due to mitochondrial encephalopathy, lactic acidosis, and stroke like episodes (melas)

patients with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (melas) present with recurrent and partially reversible neurological deficits. lesions of melas classically cause a signal change in both the grey and white matter, predominantly in the occipital and parietal lobes. these lesions mimic infarction. here, we reported a case of melas with rare neuroimaging finding of hemispheric cortical thickening on t2/flair images with intracortical nodular gadolinium enhancement; then we discussed the clinical and radiological differential diagnoses of it.