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<meta name="DC.Title" content="Cerebral Mitochondrial Microangiopathy Leads to Leukoencephalopathy in Mitochondrial Neurogastrointestinal Encephalopathy" />
<meta name="DC.Identifier" content="10.3174/ajnr.A5507" />
<meta name="DC.Date" content="2018-03-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="© 2018 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: Mitochondrial neurogastrointestinal encephalopathy is a rare disorder due to recessive mutations in the thymidine phosphorylase gene, encoding thymidine phosphorylase protein required for mitochondrial DNA replication. Clinical manifestations include gastrointestinal dysmotility and diffuse asymptomatic leukoencephalopathy. This study aimed to elucidate the mechanisms underlying brain leukoencephalopathy in patients with mitochondrial neurogastrointestinal encephalopathy by correlating multimodal neuroradiologic features to postmortem pathology.

MATERIALS AND METHODS: Seven patients underwent brain MR imaging, including single-voxel proton MR spectroscopy and diffusion imaging. Absolute concentrations of metabolites calculated by acquiring unsuppressed water spectra at multiple TEs, along with diffusion metrics based on the tensor model, were compared with those of healthy controls using unpaired t tests in multiple white matters regions. Brain postmortem histologic, immunohistochemical, and molecular analyses were performed in 1 patient.

RESULTS: All patients showed bilateral and nearly symmetric cerebral white matter hyperintensities on T2-weighted images, extending to the cerebellar white matter and brain stem in 4. White matter, N -acetylaspartate, creatine, and choline concentrations were significantly reduced compared with those in controls, with a prominent increase in the radial water diffusivity component. At postmortem examination, severe fibrosis of brain vessel smooth muscle was evident, along with mitochondrial DNA replication depletion in brain and vascular smooth-muscle and endothelial cells, without neuronal loss, myelin damage, or gliosis. Prominent periependymal cytochrome C oxidase deficiency was also observed.

CONCLUSIONS: Vascular functional and histologic alterations account for leukoencephalopathy in mitochondrial neurogastrointestinal encephalopathy. Thymidine toxicity and mitochondrial DNA replication depletion may induce microangiopathy and blood-brain-barrier dysfunction, leading to increased water content in the white matter. Periependymal cytochrome C oxidase deficiency could explain prominent periventricular impairment.

AD
:   axial diffusivity
BW
:   brain water
FA
:   fractional anisotropy
MNGIE
:   mitochondrial neurogastrointestinal encephalopathy
mtDNA
:   mitochondrial DNA replication
MD
:   mean diffusivity
PLIC
:   posterior limbs of the internal capsule
PO-WM
:   parieto-occipital white matter
RD
:   radial diffusivity" />
<meta name="DC.Contributor" content="L.L. Gramegna" />
<meta name="DC.Contributor" content="A. Pisano" />
<meta name="DC.Contributor" content="C. Testa" />
<meta name="DC.Contributor" content="D.N. Manners" />
<meta name="DC.Contributor" content="R. D'Angelo" />
<meta name="DC.Contributor" content="E. Boschetti" />
<meta name="DC.Contributor" content="F. Giancola" />
<meta name="DC.Contributor" content="L. Pironi" />
<meta name="DC.Contributor" content="L. Caporali" />
<meta name="DC.Contributor" content="M. Capristo" />
<meta name="DC.Contributor" content="M.L. Valentino" />
<meta name="DC.Contributor" content="G. Plazzi" />
<meta name="DC.Contributor" content="C. Casali" />
<meta name="DC.Contributor" content="M.T. Dotti" />
<meta name="DC.Contributor" content="G. Cenacchi" />
<meta name="DC.Contributor" content="M. Hirano" />
<meta name="DC.Contributor" content="C. Giordano" />
<meta name="DC.Contributor" content="P. Parchi" />
<meta name="DC.Contributor" content="R. Rinaldi" />
<meta name="DC.Contributor" content="R. De Giorgio" />
<meta name="DC.Contributor" content="R. Lodi" />
<meta name="DC.Contributor" content="V. Carelli" />
<meta name="DC.Contributor" content="C. Tonon" />
<meta name="article:published_time" content="2018-03-01" />
<meta name="article:section" content="Adult Brain" />
<meta name="citation_title" content="Cerebral Mitochondrial Microangiopathy Leads to Leukoencephalopathy in Mitochondrial Neurogastrointestinal Encephalopathy" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;Mitochondrial neurogastrointestinal encephalopathy is a rare disorder due to recessive mutations in the &lt;i&gt;thymidine phosphorylase&lt;/i&gt; gene, encoding thymidine phosphorylase protein required for mitochondrial DNA replication. Clinical manifestations include gastrointestinal dysmotility and diffuse asymptomatic leukoencephalopathy. This study aimed to elucidate the mechanisms underlying brain leukoencephalopathy in patients with mitochondrial neurogastrointestinal encephalopathy by correlating multimodal neuroradiologic features to postmortem pathology.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;Seven patients underwent brain MR imaging, including single-voxel proton MR spectroscopy and diffusion imaging. Absolute concentrations of metabolites calculated by acquiring unsuppressed water spectra at multiple TEs, along with diffusion metrics based on the tensor model, were compared with those of healthy controls using unpaired &lt;i&gt;t&lt;/i&gt; tests in multiple white matters regions. Brain postmortem histologic, immunohistochemical, and molecular analyses were performed in 1 patient.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;All patients showed bilateral and nearly symmetric cerebral white matter hyperintensities on T2-weighted images, extending to the cerebellar white matter and brain stem in 4. White matter, &lt;i&gt;N&lt;/i&gt;-acetylaspartate, creatine, and choline concentrations were significantly reduced compared with those in controls, with a prominent increase in the radial water diffusivity component. At postmortem examination, severe fibrosis of brain vessel smooth muscle was evident, along with mitochondrial DNA replication depletion in brain and vascular smooth-muscle and endothelial cells, without neuronal loss, myelin damage, or gliosis. Prominent periependymal cytochrome &lt;i&gt;C&lt;/i&gt; oxidase deficiency was also observed.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Vascular functional and histologic alterations account for leukoencephalopathy in mitochondrial neurogastrointestinal encephalopathy. Thymidine toxicity and mitochondrial DNA replication depletion may induce microangiopathy and blood-brain-barrier dysfunction, leading to increased water content in the white matter. Periependymal cytochrome &lt;i&gt;C&lt;/i&gt; oxidase deficiency could explain prominent periventricular impairment.&lt;/p&gt;" />
<meta name="citation_journal_title" content="American Journal of Neuroradiology" />
<meta name="citation_publisher" content="American Journal of Neuroradiology" />
<meta name="citation_publication_date" content="2018/03/01" />
<meta name="citation_mjid" content="ajnr;39/3/427" />
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<meta name="citation_issn" content="0195-6108" />
<meta name="citation_issn" content="1936-959X" />
<meta name="citation_doi" content="10.3174/ajnr.A5507" />
<meta name="citation_pmid" content="29348134" />
<meta name="citation_volume" content="39" />
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<meta name="citation_section" content="Adult Brain" />
<meta name="citation_firstpage" content="427" />
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<meta name="twitter:title" content="Cerebral Mitochondrial Microangiopathy Leads to Leukoencephalopathy in Mitochondrial Neurogastrointestinal Encephalopathy" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: Mitochondrial neurogastrointestinal encephalopathy is a rare disorder due to recessive mutations in the thymidine phosphorylase gene, encoding thymidine phosphorylase protein required for mitochondrial DNA replication. Clinical manifestations include gastrointestinal dysmotility and diffuse asymptomatic leukoencephalopathy. This study aimed to elucidate the mechanisms underlying brain leukoencephalopathy in patients with mitochondrial neurogastrointestinal encephalopathy by correlating multimodal neuroradiologic features to postmortem pathology.

MATERIALS AND METHODS: Seven patients underwent brain MR imaging, including single-voxel proton MR spectroscopy and diffusion imaging. Absolute concentrations of metabolites calculated by acquiring unsuppressed water spectra at multiple TEs, along with diffusion metrics based on the tensor model, were compared with those of healthy controls using unpaired t tests in multiple white matters regions. Brain postmortem histologic, immunohistochemical, and molecular analyses were performed in 1 patient.

RESULTS: All patients showed bilateral and nearly symmetric cerebral white matter hyperintensities on T2-weighted images, extending to the cerebellar white matter and brain stem in 4. White matter, N -acetylaspartate, creatine, and choline concentrations were significantly reduced compared with those in controls, with a prominent increase in the radial water diffusivity component. At postmortem examination, severe fibrosis of brain vessel smooth muscle was evident, along with mitochondrial DNA replication depletion in brain and vascular smooth-muscle and endothelial cells, without neuronal loss, myelin damage, or gliosis. Prominent periependymal cytochrome C oxidase deficiency was also observed.

CONCLUSIONS: Vascular functional and histologic alterations account for leukoencephalopathy in mitochondrial neurogastrointestinal encephalopathy. Thymidine toxicity and mitochondrial DNA replication depletion may induce microangiopathy and blood-brain-barrier dysfunction, leading to increased water content in the white matter. Periependymal cytochrome C oxidase deficiency could explain prominent periventricular impairment.

AD
:   axial diffusivity
BW
:   brain water
FA
:   fractional anisotropy
MNGIE
:   mitochondrial neurogastrointestinal encephalopathy
mtDNA
:   mitochondrial DNA replication
MD
:   mean diffusivity
PLIC
:   posterior limbs of the internal capsule
PO-WM
:   parieto-occipital white matter
RD
:   radial diffusivity" />
<meta name="og-title" property="og:title" content="Cerebral Mitochondrial Microangiopathy Leads to Leukoencephalopathy in Mitochondrial Neurogastrointestinal Encephalopathy" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/39/3/427" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: Mitochondrial neurogastrointestinal encephalopathy is a rare disorder due to recessive mutations in the thymidine phosphorylase gene, encoding thymidine phosphorylase protein required for mitochondrial DNA replication. Clinical manifestations include gastrointestinal dysmotility and diffuse asymptomatic leukoencephalopathy. This study aimed to elucidate the mechanisms underlying brain leukoencephalopathy in patients with mitochondrial neurogastrointestinal encephalopathy by correlating multimodal neuroradiologic features to postmortem pathology.

MATERIALS AND METHODS: Seven patients underwent brain MR imaging, including single-voxel proton MR spectroscopy and diffusion imaging. Absolute concentrations of metabolites calculated by acquiring unsuppressed water spectra at multiple TEs, along with diffusion metrics based on the tensor model, were compared with those of healthy controls using unpaired t tests in multiple white matters regions. Brain postmortem histologic, immunohistochemical, and molecular analyses were performed in 1 patient.

RESULTS: All patients showed bilateral and nearly symmetric cerebral white matter hyperintensities on T2-weighted images, extending to the cerebellar white matter and brain stem in 4. White matter, N -acetylaspartate, creatine, and choline concentrations were significantly reduced compared with those in controls, with a prominent increase in the radial water diffusivity component. At postmortem examination, severe fibrosis of brain vessel smooth muscle was evident, along with mitochondrial DNA replication depletion in brain and vascular smooth-muscle and endothelial cells, without neuronal loss, myelin damage, or gliosis. Prominent periependymal cytochrome C oxidase deficiency was also observed.

CONCLUSIONS: Vascular functional and histologic alterations account for leukoencephalopathy in mitochondrial neurogastrointestinal encephalopathy. Thymidine toxicity and mitochondrial DNA replication depletion may induce microangiopathy and blood-brain-barrier dysfunction, leading to increased water content in the white matter. Periependymal cytochrome C oxidase deficiency could explain prominent periventricular impairment.

AD
:   axial diffusivity
BW
:   brain water
FA
:   fractional anisotropy
MNGIE
:   mitochondrial neurogastrointestinal encephalopathy
mtDNA
:   mitochondrial DNA replication
MD
:   mean diffusivity
PLIC
:   posterior limbs of the internal capsule
PO-WM
:   parieto-occipital white matter
RD
:   radial diffusivity" />
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    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">L.L. Gramegna</span>, <span class="highwire-citation-author" data-delta="1">A. Pisano</span>, <span class="highwire-citation-author" data-delta="2">C. Testa</span>, <span class="highwire-citation-author" data-delta="3">D.N. Manners</span>, <span class="highwire-citation-author" data-delta="4">R. D'Angelo</span>, <span class="highwire-citation-author" data-delta="5">E. Boschetti</span>, <span class="highwire-citation-author" data-delta="6">F. Giancola</span>, <span class="highwire-citation-author" data-delta="7">L. Pironi</span>, <span class="highwire-citation-author" data-delta="8">L. Caporali</span>, <span class="highwire-citation-author" data-delta="9">M. Capristo</span>, <span class="highwire-citation-author" data-delta="10">M.L. Valentino</span>, <span class="highwire-citation-author" data-delta="11">G. Plazzi</span>, <span class="highwire-citation-author" data-delta="12">C. Casali</span>, <span class="highwire-citation-author" data-delta="13">M.T. Dotti</span>, <span class="highwire-citation-author" data-delta="14">G. Cenacchi</span>, <span class="highwire-citation-author" data-delta="15">M. Hirano</span>, <span class="highwire-citation-author" data-delta="16">C. Giordano</span>, <span class="highwire-citation-author" data-delta="17">P. Parchi</span>, <span class="highwire-citation-author" data-delta="18">R. Rinaldi</span>, <span class="highwire-citation-author" data-delta="19">R. De Giorgio</span>, <span class="highwire-citation-author" data-delta="20">R. Lodi</span>, <span class="highwire-citation-author" data-delta="21">V. Carelli</span> and <span class="highwire-citation-author" data-delta="22">C. Tonon</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">March 2018,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">427-434; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A5507 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-59508--6432568248" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">L.L. Gramegna </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Functional MR Unit (L.L.G., C.T., D.N.M., R.L., C.T.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Biomedical and Neuromotor Sciences (L.L.G., C.T., D.N.M., L.C., M.C., M.L.V., G.P., G.C., P.P., R.L., V.C., C.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.L.%2BGramegna%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gramegna%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AL.L.%2BGramegna%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-9192-5994" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L.L. Gramegna</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">A. Pisano </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Departments of Radiology, Oncology, and Pathology (A.P., C.G.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=A.%2BPisano%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pisano%20A&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AA.%2BPisano%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-4013-7701" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for A. Pisano</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">C. Testa </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Functional MR Unit (L.L.G., C.T., D.N.M., R.L., C.T.)</div><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology Unit (R.D., R.R.), S.Orsola-Malpighi Hospital, Bologna, Italy</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Biomedical and Neuromotor Sciences (L.L.G., C.T., D.N.M., L.C., M.C., M.L.V., G.P., G.C., P.P., R.L., V.C., C.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BTesta%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Testa%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BTesta%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-8591-9803" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Testa</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">D.N. Manners </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Functional MR Unit (L.L.G., C.T., D.N.M., R.L., C.T.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Biomedical and Neuromotor Sciences (L.L.G., C.T., D.N.M., L.C., M.C., M.L.V., G.P., G.C., P.P., R.L., V.C., C.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=D.N.%2BManners%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Manners%20D&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AD.N.%2BManners%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-2404-1101" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for D.N. Manners</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">R. D'Angelo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology Unit (R.D., R.R.), S.Orsola-Malpighi Hospital, Bologna, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BD%27Angelo%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=D%27Angelo%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.%2BD%2527Angelo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-0941-3891" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. D'Angelo</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">E. Boschetti </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Surgical and Medical Sciences (E.B., F.G., L.P., R.D.G.), University of Bologna, Bologna, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=E.%2BBoschetti%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Boschetti%20E&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AE.%2BBoschetti%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-4503-2770" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for E. Boschetti</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">F. Giancola </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Surgical and Medical Sciences (E.B., F.G., L.P., R.D.G.), University of Bologna, Bologna, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=F.%2BGiancola%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Giancola%20F&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AF.%2BGiancola%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-0131-8307" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for F. Giancola</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">L. Pironi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Surgical and Medical Sciences (E.B., F.G., L.P., R.D.G.), University of Bologna, Bologna, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.%2BPironi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Pironi%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AL.%2BPironi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1773-8330" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L. Pironi</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">L. Caporali </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Biomedical and Neuromotor Sciences (L.L.G., C.T., D.N.M., L.C., M.C., M.L.V., G.P., G.C., P.P., R.L., V.C., C.T.)</div><div class='author-affiliation'><span class='nlm-sup'>g</span>Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurological Sciences (L.C., M.C., M.L.V., G.P., P.P., V.C.), Bologna, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=L.%2BCaporali%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Caporali%20L&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AL.%2BCaporali%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-0666-4380" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for L. Caporali</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">M. Capristo </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Biomedical and Neuromotor Sciences (L.L.G., C.T., D.N.M., L.C., M.C., M.L.V., G.P., G.C., P.P., R.L., V.C., C.T.)</div><div class='author-affiliation'><span class='nlm-sup'>g</span>Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurological Sciences (L.C., M.C., M.L.V., G.P., P.P., V.C.), Bologna, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BCapristo%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Capristo%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BCapristo%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-9774-3633" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Capristo</a></li></ul></div><div class="author-tooltip-10"><div class="author-tooltip-name">M.L. Valentino </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Biomedical and Neuromotor Sciences (L.L.G., C.T., D.N.M., L.C., M.C., M.L.V., G.P., G.C., P.P., R.L., V.C., C.T.)</div><div class='author-affiliation'><span class='nlm-sup'>g</span>Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurological Sciences (L.C., M.C., M.L.V., G.P., P.P., V.C.), Bologna, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.L.%2BValentino%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Valentino%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.L.%2BValentino%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5323-0115" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.L. Valentino</a></li></ul></div><div class="author-tooltip-11"><div class="author-tooltip-name">G. Plazzi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Biomedical and Neuromotor Sciences (L.L.G., C.T., D.N.M., L.C., M.C., M.L.V., G.P., G.C., P.P., R.L., V.C., C.T.)</div><div class='author-affiliation'><span class='nlm-sup'>g</span>Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurological Sciences (L.C., M.C., M.L.V., G.P., P.P., V.C.), Bologna, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BPlazzi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Plazzi%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.%2BPlazzi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-1051-0472" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Plazzi</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">C. Casali </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>f</span>Medico-Surgical Sciences and Biotechnologies (C.C.), Sapienza, University of Rome, Rome, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BCasali%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Casali%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BCasali%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-8819-9274" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Casali</a></li></ul></div><div class="author-tooltip-13"><div class="author-tooltip-name">M.T. Dotti </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>h</span>Department of Medicine, Surgery, and Neuroscience (M.T.D.), University of Siena, Siena, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.T.%2BDotti%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Dotti%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.T.%2BDotti%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5731-5642" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M.T. Dotti</a></li></ul></div><div class="author-tooltip-14"><div class="author-tooltip-name">G. Cenacchi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Biomedical and Neuromotor Sciences (L.L.G., C.T., D.N.M., L.C., M.C., M.L.V., G.P., G.C., P.P., R.L., V.C., C.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=G.%2BCenacchi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Cenacchi%20G&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AG.%2BCenacchi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0001-5824-3118" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for G. Cenacchi</a></li></ul></div><div class="author-tooltip-15"><div class="author-tooltip-name">M. Hirano </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>i</span>Department of Neurology (M.H.), Columbia University Medical Centre, New York, New York.</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=M.%2BHirano%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hirano%20M&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AM.%2BHirano%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-7070-7402" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for M. Hirano</a></li></ul></div><div class="author-tooltip-16"><div class="author-tooltip-name">C. Giordano </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>e</span>Departments of Radiology, Oncology, and Pathology (A.P., C.G.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=C.%2BGiordano%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Giordano%20C&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AC.%2BGiordano%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-3716-4303" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for C. Giordano</a></li></ul></div><div class="author-tooltip-17"><div class="author-tooltip-name">P. Parchi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Biomedical and Neuromotor Sciences (L.L.G., C.T., D.N.M., L.C., M.C., M.L.V., G.P., G.C., P.P., R.L., V.C., C.T.)</div><div class='author-affiliation'><span class='nlm-sup'>g</span>Istituto di Ricovero e Cura a Carattere Scientifico Institute of Neurological Sciences (L.C., M.C., M.L.V., G.P., P.P., V.C.), Bologna, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=P.%2BParchi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Parchi%20P&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AP.%2BParchi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-9444-9524" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for P. Parchi</a></li></ul></div><div class="author-tooltip-18"><div class="author-tooltip-name">R. Rinaldi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>b</span>Neurology Unit (R.D., R.R.), S.Orsola-Malpighi Hospital, Bologna, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BRinaldi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Rinaldi%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.%2BRinaldi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0002-4564-7284" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. Rinaldi</a></li></ul></div><div class="author-tooltip-19"><div class="author-tooltip-name">R. De Giorgio </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>d</span>Surgical and Medical Sciences (E.B., F.G., L.P., R.D.G.), University of Bologna, Bologna, Italy</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BDe%2BGiorgio%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=De%20Giorgio%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.%2BDe%2BGiorgio%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-0867-5873" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. De Giorgio</a></li></ul></div><div class="author-tooltip-20"><div class="author-tooltip-name">R. Lodi </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>a</span>From the Functional MR Unit (L.L.G., C.T., D.N.M., R.L., C.T.)</div><div class='author-affiliation'><span class='nlm-sup'>c</span>Departments of Biomedical and Neuromotor Sciences (L.L.G., C.T., D.N.M., L.C., M.C., M.L.V., G.P., G.C., P.P., R.L., V.C., C.T.)</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=R.%2BLodi%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lodi%20R&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AR.%2BLodi%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-orcid-link last"><a href="http://orcid.org/0000-0003-3878-304X" target="_blank" class="" data-icon-position="" data-hide-link-title="0">ORCID record for R. Lodi</a></li></ul></div><div class="author-tooltip-21"><div class="author-tooltip-name">V. 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        	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 39</span>, <span  class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 3 </span><div  class="highwire-cite-metadata-pubdate highwire-cite-metadata">1 Mar 2018 </div></div>
      
      
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      <div class="highwire-cite-title">Cerebral Mitochondrial Microangiopathy Leads to Leukoencephalopathy in Mitochondrial Neurogastrointestinal Encephalopathy</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">L.L.</span> <span class="nlm-surname">Gramegna</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Pisano</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Testa</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.N.</span> <span class="nlm-surname">Manners</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">R.</span> <span class="nlm-surname">D'Angelo</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Boschetti</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Giancola</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Pironi</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Caporali</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Capristo</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">M.L.</span> <span class="nlm-surname">Valentino</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Plazzi</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Casali</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">M.T.</span> <span class="nlm-surname">Dotti</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Cenacchi</span></span>, <span class="highwire-citation-author" data-delta="15"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Hirano</span></span>, <span class="highwire-citation-author" data-delta="16"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Giordano</span></span>, <span class="highwire-citation-author" data-delta="17"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Parchi</span></span>, <span class="highwire-citation-author" data-delta="18"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Rinaldi</span></span>, <span class="highwire-citation-author" data-delta="19"><span class="nlm-given-names">R.</span> <span class="nlm-surname">De Giorgio</span></span>, <span class="highwire-citation-author" data-delta="20"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Lodi</span></span>, <span class="highwire-citation-author" data-delta="21"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Carelli</span></span>, <span class="highwire-citation-author" data-delta="22"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Tonon</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">427-434; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5507 </span></div>
  
  
  
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      <div class="highwire-cite-title">Cerebral Mitochondrial Microangiopathy Leads to Leukoencephalopathy in Mitochondrial Neurogastrointestinal Encephalopathy</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">L.L.</span> <span class="nlm-surname">Gramegna</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Pisano</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Testa</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">D.N.</span> <span class="nlm-surname">Manners</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">R.</span> <span class="nlm-surname">D'Angelo</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">E.</span> <span class="nlm-surname">Boschetti</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">F.</span> <span class="nlm-surname">Giancola</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Pironi</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">L.</span> <span class="nlm-surname">Caporali</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Capristo</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">M.L.</span> <span class="nlm-surname">Valentino</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Plazzi</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Casali</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">M.T.</span> <span class="nlm-surname">Dotti</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">G.</span> <span class="nlm-surname">Cenacchi</span></span>, <span class="highwire-citation-author" data-delta="15"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Hirano</span></span>, <span class="highwire-citation-author" data-delta="16"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Giordano</span></span>, <span class="highwire-citation-author" data-delta="17"><span class="nlm-given-names">P.</span> <span class="nlm-surname">Parchi</span></span>, <span class="highwire-citation-author" data-delta="18"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Rinaldi</span></span>, <span class="highwire-citation-author" data-delta="19"><span class="nlm-given-names">R.</span> <span class="nlm-surname">De Giorgio</span></span>, <span class="highwire-citation-author" data-delta="20"><span class="nlm-given-names">R.</span> <span class="nlm-surname">Lodi</span></span>, <span class="highwire-citation-author" data-delta="21"><span class="nlm-given-names">V.</span> <span class="nlm-surname">Carelli</span></span>, <span class="highwire-citation-author" data-delta="22"><span class="nlm-given-names">C.</span> <span class="nlm-surname">Tonon</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-oa-ind highwire-cite-metadata"><i class="highwire-oa-indicator"></i> </span><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2018, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">39 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">427-434; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A5507 </span></div>
  
  
  
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