Teaching NeuroImage: Multiple Symmetric Lipomatosis as a Manifestation of Mitochondrial Cytopathy

A 47-year-old man presented with proximal weakness at the age of 41 years, initially involving the lower limbs, followed by the upper limbs and neck.Examination revealed scapular winging, pes cavus, scoliosis, and multiple, symmetrical, paramedian subcutaneous lipomas over the Figure 1 Clinical Findings Physical Examination reveals (A) bilateral paramedian subcutaneous lipomatosis over the shoulders and back with scapular winging.(B) Foot imprint demonstrates pes cavus deformity.(C) Fundoscopic images of the right (Rt) and left (Lt) optic discs reveal bilateral optic atrophy.