Abstract：
A 40-year-old man with sensorineural hearing loss and diabetes mellitus was hospitalized with acute-onset impaired consciousness and clumsiness in his left hand. He had been taking metformin for 4 months. A neurological examination revealed confusion and weakness in the left upper limb. Increased lactate levels were detected in the serum and cerebrospinal fluid. Magnetic resonance imaging revealed lesions in the right parietal and bilateral temporal lobes with a lactate peak in magnetic resonance spectroscopy. Finally, we made a genetic diagnosis of mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes based on the detection of m.3243A>G. It is well-known that metformin should not be administered in patients with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes because metformin inhibits mitochondrial function and triggers stroke-like episodes. However, our patient was diagnosed with mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes after metformin administration. Thus, we encourage physicians to exercise caution in the prescription of metformin in patients with short stature, sensorineural hearing loss, or young-onset diabetes mellitus because these patients may have undiagnosed mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes.
摘要：
一名患有感觉神经性听力损失和糖尿病的40岁男子因左手急性发作意识障碍和笨拙而住院。他已经服用二甲双胍4个月了。神经系统检查显示左上肢混乱和无力。在血清和脑脊液中检测到乳酸水平升高。磁共振成像显示右顶叶和双侧颞叶病变，磁共振波谱显示乳酸峰。最后,我们做了线粒体脑病的基因诊断,乳酸性酸中毒,和基于m.3243A>G的检测的中风样发作众所周知，二甲双胍不应用于线粒体脑病患者，乳酸性酸中毒,和中风样发作，因为二甲双胍抑制线粒体功能并引发中风样发作。然而,我们的病人被诊断为线粒体脑病,乳酸性酸中毒,和服用二甲双胍后的中风样发作。因此，我们鼓励医生在对身材矮小的患者服用二甲双胍时谨慎，感觉神经性听力损失,或年轻发病的糖尿病，因为这些患者可能患有未诊断的线粒体脑病，乳酸性酸中毒,和类似中风的发作。
