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Wu S, Zhao N, Sun T, Cui F, Sun X, Lin J. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) with multiple different onset forms of frequent recurrent attacks: A case report and literature review. Medicine (Baltimore) 2024; 103:e37563. [PMID: 38489688 PMCID: PMC10939672 DOI: 10.1097/md.0000000000037563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is one kind of monogenic hereditary small-vessel disease in the brain caused by mutations in the NOTCH3 gene. However, it is rare for CADASIL to recur with different clinical manifestations in 1 patient, and some atypical clinical manifestations can easily lead to misdiagnosis by clinical physicians. CASE CONCERN A 34-year-old male presented with transient speech disorder accompanied by weakness in the left side of the body for 1 day in June 2020. Magnetic resonance imaging showed acute ischemic infarction in right centrum semiovale, along with multiple abnormal white matter hyperintensities in the brain. Genetic sequencing identified a heterozygous mutation in the NOTCH3 gene. The patient experienced recurrent episodes in 2021 and 2023, with varying clinical symptoms including visual blurring, abnormal limb sensation, and sudden cognitive dysfunction. DIAGNOSIS The diagnoses of CADASIL is based on clinical manifestations, imaging results, and genetic reports. INTERVISION AND OUTCOMES The patient was received symptomatic treatment including antiplatelet aggregation therapy, lipid regulation, and plaque stabilization, resulting in improved symptoms. OUTCOMES During the course of the disease, after medication treatment and rehabilitation exercise, the patient clinical symptoms have significantly improved. Currently, the patient is closely following up and regularly undergoing relevant examinations. LESSONS In this rare case, we found that CADASIL can recur multiple times in a patient with different clinical symptoms, which can easily lead to clinical misdiagnosis. Clinicians should consider the possibility of CADASIL in young patients with sudden typical neurological dysfunction.
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Affiliation(s)
- Siting Wu
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Ning Zhao
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Tingting Sun
- Department of Orthopaedics, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Fang Cui
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Xianli Sun
- Department of Health Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Jiacai Lin
- Department of Neurology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
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Moura J, Mendes Pinto C, Pinto P, Santos E. Inflammatory Optic Neuropathy as a Presenting Feature of Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy. Neurohospitalist 2023; 13:183-187. [PMID: 37064940 PMCID: PMC10091426 DOI: 10.1177/19418744221132677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is commonly associated with early-onset stroke, migraine and vascular dementia. However, optic nerve involvement has been previously recognised. Results: We report a case of a 21-year-old female presenting with right inferior temporal scotoma, dyschromatopsia, relative pupillary afferent defect and bilateral disk oedema in the fundoscopic examination. Visual evoked potential latencies were bilaterally increased, suggesting optic neuropathy. Cerebrospinal fluid (CSF) evaluation showed 11 leukocytes, .45 mg/dL proteins, elevated IgG (4.55 mg/dL) and 2 oligoclonal bands (OCB) restricted to the CSF. ESR was 17 mm/h and CRP 5 mg/dL. Anti-Aquaporin4 anti-MOG antibodies were negative. The MRI showed right optic nerve hyperintensity, enhancing after the administration of contrast product, and multiple FLAIR focal lesions present throughout the white matter, with a noticeable confluence in the anterior temporal horns. She improved after IV high-dose methylprednisolone. Because the lesions of the white matter were highly atypical for an inflammatory disease and highly suggestive of CADASIL genetic testing was requested. A heterozygous pathogenic variant c994C>T p (Arg332Cys) in the exon 6 of the NOTCH3 gene, compatible with the diagnosis of CADASIL was found. Conclusions: This case highlights isolated optic nerve involvement as a presenting feature of CADASIL, possibly reflecting an inflammatory process associated with this hereditary vasculopathy.
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Affiliation(s)
- João Moura
- Department of Neurology, Centro Hospitalar Universitário do
Porto, Portugal
| | | | - Pedro Pinto
- Department of Neuroradiology, Centro Hospitalar Universitário do
Porto, Portugal
| | - Ernestina Santos
- Department of Neurology, Centro Hospitalar Universitário do
Porto, Portugal
- Unit for Multidisciplinary Research in
Biomedicine (UMIB), Instituto de Ciencias Biomedicas de Abel Salazar, Universidade do Porto, Portugal
- Clinical Immunology Unit, Centro Hospitalar Universitário do
Porto, Portugal
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3
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Mukai M, Hamano A, Mizuta I, Yokota I, Watanabe-Hosomi A, Matsuura H, Koizumi T, Matsuura J, Ohara T, Matsushima S, Teramukai S, Yamada K, Mizuno T. Association between cerebrovasoreactivity and stroke in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Front Neurol 2023; 13:1087220. [PMID: 36698906 PMCID: PMC9868304 DOI: 10.3389/fneur.2022.1087220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Background Impaired cerebrovasoreactivity is thought to play an important role in the pathophysiology of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We aimed to clarify the association between cerebrovascular reactivity and stroke in patients with CADASIL. Methods We retrospectively recruited 14 patients with CADASIL, eight of whom had symptomatic stroke. They underwent quantitative single-photon emission computed tomography using an autoradiographic method at rest and after acetazolamide (ACZ) administration. Regional cerebral blood flow (rCBF) in the cerebral cortex, lenticular nucleus, thalamus, and cerebellum was measured. We compared the rCBF parameters between patients with and without stroke. Results The baseline characteristics and magnetic resonance imaging findings were similar between the two groups, except for a higher frequency of pyramidal tract sign (75% vs. 0%) and a larger number of old lacunes (15.4 ± 8.8 vs. 2.2 ± 1.8) in the patients with stroke. Of the rCBF parameters measured, significantly lower flow (mL/100 g/min) was observed in ACZ-rCBF in the thalamus (35.6 ± 9.4 vs. 51.1 ± 7.6, p = 0.01) and ΔrCBF in the thalamus (10.6 ± 3.7 vs. 21.0 ± 7.9, p = 0.02) in the patients with stroke. Conclusion Cerebrovasoreactivity in the thalamus was significantly associated with stroke in patients with CADASIL.
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Affiliation(s)
- Mao Mukai
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ai Hamano
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ikuko Mizuta
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Akiko Watanabe-Hosomi
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiraku Matsuura
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Takashi Koizumi
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan,Department of Anatomy and Neurobiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Jun Matsuura
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoyuki Ohara
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Shigenori Matsushima
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kei Yamada
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan,*Correspondence: Toshiki Mizuno ✉
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Abdelhak A, Solomon I, Montes SC, Saias A, Cordano C, Asken B, Fonseca C, Oertel FC, Arfanakis K, Staffaroni AM, Kramer JH, Geschwind M, Miller BL, Elahi FM, Green AJ. Retinal arteriolar parameters as a surrogate marker of intracranial vascular pathology. Alzheimers Dement (Amst) 2022; 14:e12338. [PMID: 35814617 PMCID: PMC9257197 DOI: 10.1002/dad2.12338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 11/10/2022]
Abstract
Introduction Development of novel diagnostic tools is a top research priority in vascular dementia. A major obstacle is the lack of a simple, non-invasive method to visualize cerebral arteriolar walls in vivo. Retinal arterioles offer a window into the cerebral circulation. Methods Intensity-based retinal arteriolar visualization in optical coherence tomography (I-bRAVO) was applied to evaluate mean wall thickness (MWT) and wall-to-lumen ratio (WLR) in 250 subjects with sporadic and genetic cerebral small vessel disease (CSVD), non-vascular neurodegenerative diseases (NVND), and healthy controls (HC) in association with imaging and cognitive markers. Results MWT and WLR were higher in CSVD, associated with severity of vascular white matter lesions, and correlated with magnetic resonance imaging-based intracranial arteriolosclerosis score. WLR correlated with gray and white matter volume and differentiated asymptomatic sporadic CSVD from HC (area under the curve = 0.82). Discussion I-bRAVO is a rapid, non-invasive tool. MWT and WLR were associated with imaging markers of CSVD and could contribute to early identification of sporadic CSVD.
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Affiliation(s)
- Ahmed Abdelhak
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Isaac Solomon
- San Diego School of MedicineUniversity of California, San DiegoLa JollaCaliforniaUSA
| | - Shivany Condor Montes
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Alexandra Saias
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Christian Cordano
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Breton Asken
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Corrina Fonseca
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Frederike Cosima Oertel
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Konstantinos Arfanakis
- Department of Biomedical EngineeringIllinois Institute of TechnologyChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Adam M. Staffaroni
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Joel H. Kramer
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Michael Geschwind
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Bruce L. Miller
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
| | - Fanny M. Elahi
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
- San Francisco Veterans Affairs Health Care System
| | - Ari J. Green
- Weill Institute for NeurosciencesDepartment of NeurologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
- Department of OphthalmologyUniversity of California at San Francisco (UCSF)San FranciscoCaliforniaUSA
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5
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Littau JL, Velilla L, Hase Y, Villalba-Moreno ND, Hagel C, Drexler D, Osorio Restrepo S, Villegas A, Lopera F, Vargas S, Glatzel M, Krasemann S, Quiroz YT, Arboleda-Velasquez JF, Kalaria R, Sepulveda-Falla D. Evidence of beta amyloid independent small vessel disease in familial Alzheimer's disease. Brain Pathol 2022; 32:e13097. [PMID: 35695802 PMCID: PMC9616091 DOI: 10.1111/bpa.13097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 05/24/2022] [Indexed: 12/04/2022] Open
Abstract
We studied small vessel disease (SVD) pathology in Familial Alzheimer's disease (FAD) subjects carrying the presenilin 1 (PSEN1) p.Glu280Ala mutation in comparison to those with sporadic Alzheimer's disease (SAD) as a positive control for Alzheimer's pathology and Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) bearing different NOTCH3 mutations, as positive controls for SVD pathology. Upon magnetic resonance imaging (MRI) in life, some FAD showed mild white matter hyperintensities and no further radiologic evidence of SVD. In post‐mortem studies, total SVD pathology in cortical areas and basal ganglia was similar in PSEN1 FAD and CADASIL subjects, except for the feature of arteriosclerosis which was higher in CADASIL subjects than in PSEN1 FAD subjects. Further only a few SAD subjects showed a similar degree of SVD pathology as observed in CADASIL. Furthermore, we found significantly enlarged perivascular spaces in vessels devoid of cerebral amyloid angiopathy in FAD compared with SAD and CADASIL subjects. As expected, there was greater fibrinogen‐positive perivascular reactivity in CADASIL but similar reactivity in PSEN1 FAD and SAD groups. Fibrinogen immunoreactivity correlated with onset age in the PSEN1 FAD cases, suggesting increased vascular permeability may contribute to cognitive decline. Additionally, we found reduced perivascular expression of PDGFRβ AQP4 in microvessels with enlarged PVS in PSEN1 FAD cases. We demonstrate that there is Aβ‐independent SVD pathology in PSEN1 FAD, that was marginally lower than that in CADASIL subjects although not evident by MRI. These observations suggest presence of covert SVD even in PSEN1, contributing to disease progression. As is the case in SAD, these consequences may be preventable by early recognition and actively controlling vascular disease risk, even in familial forms of dementia.
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Affiliation(s)
- Jessica Lisa Littau
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lina Velilla
- Neuroscience Group of Antioquia, University of Antioquia, Medellín
| | - Yoshiki Hase
- Neurovascular Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne
| | | | - Christian Hagel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dagmar Drexler
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Andres Villegas
- Neuroscience Group of Antioquia, University of Antioquia, Medellín
| | - Francisco Lopera
- Neuroscience Group of Antioquia, University of Antioquia, Medellín
| | - Sergio Vargas
- Department of Radiology, Neuroradiology Section, Universidad de Antioquia, Medellín, Colombia
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Krasemann
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Yakeel T Quiroz
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph F Arboleda-Velasquez
- Schepens Eye Research Institute of Mass Eye and Ear and the Department of Ophthalmology at Harvard Medical School, Boston, Massachusetts
| | - Rajesh Kalaria
- Neurovascular Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne
| | - Diego Sepulveda-Falla
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Neuroscience Group of Antioquia, University of Antioquia, Medellín
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Abstract
PURPOSE OF REVIEW Recent advances in genetic evaluation improved the identification of several variants in the NOTCH3 gene causing Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL). Despite improved diagnosis, the disease mechanism remains an elusive target and an increasing number of scientific/clinical groups are investigating CADASIL to better understand it. The purpose of this review is to summarize the current knowledge in CADASIL. RECENT FINDINGS CADASIL is a genotypically and phenotypically diverse condition involving multiple molecular systems affecting small blood vessels. Cerebral white matter changes observed by MRI are a key CADASIL characteristic in young adult patients often before severe symptoms and trigger NOTCH3 genetic testing. NOTCH3 mutation locations are highly variable, correlate to disease severity and consistently affect the cysteine balance within extracellular Notch3. Granular osmiophilic material deposits around blood vessels are also a unique CADASIL feature and appear to have a role in sequestering proteins that are essential for blood vessel homeostasis. As potential biomarkers and therapeutic targets are being actively investigated, neurofilament light chain can be detected in patient serum and may be a promising circulating biomarker. SUMMARY CADASIL is a complex, devastating disease with unknown mechanism and no treatment options. As we increase our understanding of CADASIL, translational research bridging basic science and clinical findings needs to drive biomarker and therapeutic target discovery.
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Affiliation(s)
- Elisa A Ferrante
- National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
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Wallaert L, Hagiwara A, Andica C, Hori M, Yamashiro K, Koshino S, Maekawa T, Kamagata K, Aoki S. The Advantage of Synthetic MRI for the Visualization of Anterior Temporal Pole Lesions on Double Inversion Recovery (DIR), Phase-sensitive Inversion Recovery (PSIR), and Myelin Images in a Patient with CADASIL. Magn Reson Med Sci 2017; 17:275-276. [PMID: 29238005 PMCID: PMC6196308 DOI: 10.2463/mrms.ci.2017-0110] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Lauren Wallaert
- Department of Radiology, Reims Champagne-Ardennes University.,Department of Radiology, Juntendo University School of Medicine
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University School of Medicine.,Department of Radiology, Graduate School of Medicine, The University of Tokyo
| | | | - Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine
| | - Kazuo Yamashiro
- Department of Neurology, Juntendo University School of Medicine
| | - Saori Koshino
- Department of Radiology, Juntendo University School of Medicine.,Department of Radiology, Graduate School of Medicine, The University of Tokyo
| | - Tomoko Maekawa
- Department of Radiology, Juntendo University School of Medicine.,Department of Radiology, Graduate School of Medicine, The University of Tokyo
| | - Koji Kamagata
- Department of Radiology, Juntendo University School of Medicine
| | - Shigeki Aoki
- Department of Radiology, Juntendo University School of Medicine
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Moreton FC, Düring M, Phan T, Srikanth V, Beare R, Huang X, Jouvent E, Chabriat H, Dichgans M, Muir KW. Arterial branching and basal ganglia lacunes: A study in pure small vessel disease. Eur Stroke J 2017; 2:264-271. [PMID: 31008320 DOI: 10.1177/2396987317718450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 06/02/2017] [Indexed: 01/17/2023] Open
Abstract
Introduction Lacunes are defined morphologically by size and location, but radiological characteristics alone may be unable to distinguish small vessel disease aetiology from alternative mechanisms. We investigated the branching order of arterial vessels associated with basal ganglia lacunes in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), in order to improve the understanding of their pathogenesis in pure cerebral small vessel disease. Patients and methods Adults with a confirmed diagnosis of CADASIL were included. A pilot study was conducted in a Scottish CADASIL cohort. The Paris-Munich CADASIL cohort was used for independent validation. Lacunes identified on T1-weighted magnetic resonance imaging scans were registered to a standard brain template. A microangiographic template of the basal ganglia vasculature was automatically overlaid onto coronal slices, and raters estimated the vessel branching order related to each lacune. Results Of 179 lacunes, 150 (84%) were associated with third-order vessels. In 14 incident lacunes, 11 (79%) were associated with third-order vessels. In the pilot study, lacune volume was significantly lower in lacunes associated with third-order vessels (0.04 ml ± 0.04 ml) compared to second-order vessels (0.48 ± 0.16 ml; p < 0.001). Discussion In this study of CADASIL patients, most lacunes were small and associated with third-order vessel disease. This suggests that these are the vessels primarily affected in cerebral small vessel disease. Microangiographic template techniques could be used to further investigate in a general stroke population whether finding large lacunes originating from higher order vessels indicates an alternative cause of stroke. Conclusion Lacunes in pure small vessel disease are associated with the smallest vessels in the basal ganglia.
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Affiliation(s)
- Fiona C Moreton
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Marco Düring
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - Thanh Phan
- Faculty of Medicine, Nursing and Heath Sciences, Monash University, Melbourne, Australia
| | - Velandai Srikanth
- Faculty of Medicine, Nursing and Heath Sciences, Monash University, Melbourne, Australia
| | - Richard Beare
- Faculty of Medicine, Nursing and Heath Sciences, Monash University, Melbourne, Australia
| | - Xuya Huang
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, Scotland
| | - Eric Jouvent
- Department of Neurology, DHU NeuroVasc, University Paris Diderot and INSERM UMRS 1161, Paris, France
| | - Hugues Chabriat
- Department of Neurology, DHU NeuroVasc, University Paris Diderot and INSERM UMRS 1161, Paris, France
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany
| | - Keith W Muir
- Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, Glasgow, Scotland
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Choi BW, Park S, Kim HJ. Possible Role of a Missense Mutation of p.P167S on NOTCH3 Gene Associated with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy. Dement Neurocogn Disord 2016; 15:52-4. [PMID: 30906341 DOI: 10.12779/dnd.2016.15.2.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 06/16/2016] [Accepted: 06/16/2016] [Indexed: 11/27/2022] Open
Abstract
Background Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a single-gene disorder caused by mutations in the NOTCH3 gene, located on chromosome 19p13. NOTCH3 encodes a transmembrane receptor which plays a role in cellular differentiation and cell cycle regulation. Case Report A 71-year-old female showing headache and memory impairment, familial history of stroke and having a missense mutation from proline to serine at codon 167 in the exon 4 on NOTCH3 gene. Five family members revealed the same mutation (c.499C>T), who presented migrainous headache and stroke. In this study, we have uncovered a novel NOTCH3 mutation at the nucleotide position 499 (c.499C>T; p.P167S) in a family with CADASIL. Conclusions We suggested a missense mutation of proline to serine at codon 167 in exon 4 of the NOTCH3 gene, which resulted in the substitution of cytosine to thymine (c.499C>T) resulting migraine, stroke and vascular cognitive impairment.
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Ozaki K, Irioka T, Ishikawa K, Mizusawa H. CADASIL with a novel NOTCH3 mutation (Cys478Tyr). J Stroke Cerebrovasc Dis 2015; 24:e61-2. [PMID: 25595846 DOI: 10.1016/j.jstrokecerebrovasdis.2014.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 05/29/2014] [Accepted: 05/31/2014] [Indexed: 11/21/2022] Open
Abstract
Recently, an increasing number of NOTCH3 mutations have been described to cause cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Here, we report 2 CADASIL patients from a Japanese family, who were found to possess a novel NOTCH3 mutation. The proband only had chronic headache, and her mother had previously suffered a minor stroke. Although the patients' clinical symptoms were mild, their distinctive magnetic resonance imaging (MRI) features suggested CADASIL. Genetic analysis revealed that both patients had a novel heterozygous NOTCH3 mutation (p.Cys478Tyr) leading to stereotypical cysteine loss. The present finding suggests that genetic testing for NOTCH3 mutations in patients with distinctive MRI features, even if the symptoms are as mild as chronic headache, should help to broaden the mutational and clinical spectrum of CADASIL.
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11
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Choi JC. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy: a genetic cause of cerebral small vessel disease. J Clin Neurol 2010; 6:1-9. [PMID: 20386637 PMCID: PMC2851292 DOI: 10.3988/jcn.2010.6.1.1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 11/25/2009] [Accepted: 11/25/2009] [Indexed: 11/17/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a single-gene disorder of the cerebral small blood vessels caused by mutations in the Notch3 gene. The exact prevalence of this disorder was unknown currently, and the number of reported CADASIL families is steadily increasing as the clinical picture and diagnostic examinations are becoming more widely known. The main clinical manifestations are recurrent stroke, migraine, psychiatric symptoms, and progressive cognitive impairment. The clinical course of CADASIL is highly variable, even within families. The involvement of the anterior temporal lobe and the external capsule on brain magnetic resonance imaging was found to have high sensitivity and specificity in differentiating CADASIL from the much more common sporadic cerebral small-vessel disease (SVD). The pathologic hallmark of the disease is the presence of granular osmiophilic material in the walls of affected vessels. CADASIL is a prototype single-gene disorder that has evolved as a unique model for studying the mechanisms underlying cerebral SVD. At present, the incidence and prevalence of CADASIL seem to be underestimated due to limitations in clinical, neuroradiological, and genetic diagnoses of this disorder.
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Affiliation(s)
- Jay Chol Choi
- Department of Neurology and Institute of Medical Science, Jeju National University School of Medicine, Jeju, Korea
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