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Biesbroek JM, Coenen M, DeCarli C, Fletcher EM, Maillard PM, Barkhof F, Barnes J, Benke T, Chen CPLH, Dal‐Bianco P, Dewenter A, Duering M, Enzinger C, Ewers M, Exalto LG, Franzmeier N, Hilal S, Hofer E, Koek HL, Maier AB, McCreary CR, Papma JM, Paterson RW, Pijnenburg YAL, Rubinski A, Schmidt R, Schott JM, Slattery CF, Smith EE, Sudre CH, Steketee RME, Teunissen CE, van den Berg E, van der Flier WM, Venketasubramanian N, Venkatraghavan V, Vernooij MW, Wolters FJ, Xin X, Kuijf HJ, Biessels GJ. Amyloid pathology and vascular risk are associated with distinct patterns of cerebral white matter hyperintensities: A multicenter study in 3132 memory clinic patients. Alzheimers Dement 2024; 20:2980-2989. [PMID: 38477469 PMCID: PMC11032573 DOI: 10.1002/alz.13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/14/2024]
Abstract
INTRODUCTION White matter hyperintensities (WMH) are associated with key dementia etiologies, in particular arteriolosclerosis and amyloid pathology. We aimed to identify WMH locations associated with vascular risk or cerebral amyloid-β1-42 (Aβ42)-positive status. METHODS Individual patient data (n = 3,132; mean age 71.5 ± 9 years; 49.3% female) from 11 memory clinic cohorts were harmonized. WMH volumes in 28 regions were related to a vascular risk compound score (VRCS) and Aß42 status (based on cerebrospinal fluid or amyloid positron emission tomography), correcting for age, sex, study site, and total WMH volume. RESULTS VRCS was associated with WMH in anterior/superior corona radiata (B = 0.034/0.038, p < 0.001), external capsule (B = 0.052, p < 0.001), and middle cerebellar peduncle (B = 0.067, p < 0.001), and Aß42-positive status with WMH in posterior thalamic radiation (B = 0.097, p < 0.001) and splenium (B = 0.103, p < 0.001). DISCUSSION Vascular risk factors and Aß42 pathology have distinct signature WMH patterns. This regional vulnerability may incite future studies into how arteriolosclerosis and Aß42 pathology affect the brain's white matter. HIGHLIGHTS Key dementia etiologies may be associated with specific patterns of white matter hyperintensities (WMH). We related WMH locations to vascular risk and cerebral Aβ42 status in 11 memory clinic cohorts. Aβ42 positive status was associated with posterior WMH in splenium and posterior thalamic radiation. Vascular risk was associated with anterior and infratentorial WMH. Amyloid pathology and vascular risk have distinct signature WMH patterns.
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Suh YR, Lee HK, Jung KH, Lee JS, Choi JC. [Neuroimaging Characteristics of Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) in Korean Based on Jeju Cohort: A Pictorial Essay]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:855-865. [PMID: 37559811 PMCID: PMC10407072 DOI: 10.3348/jksr.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/14/2023] [Accepted: 03/16/2023] [Indexed: 08/11/2023]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary small artery vasculopathy caused by mutations in the NOTCH3 gene on chromosome 19. Jeju Island has the highest reported prevalence of CADASIL patients in the world. Even though most studies on the neuroimaging characteristics of CADASIL have focused on Western populations, there are notable differences in Korean CADASIL patients compared to those in Western countries, which may impact their clinical manifestations and prognosis. Herein, this pictorial essay presents the neuroimaging patterns of CADASIL in patients in Korea, with an emphasis on the differences observed from previous reports based on a Western patient population.
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Olszewska DA, Rawal S, Fearon C, Alcaide‐Leon P, Stell R, Paramanandan V, Lynch T, Jawad T, Vittal P, Barton B, Miyajima H, Kono S, Kandadai RM, Borgohain R, Lang AE. Neuroimaging Pearls from the MDS Congress Video Challenge. Part 1: Genetic Disorders. Mov Disord Clin Pract 2022; 9:297-310. [PMID: 35402643 PMCID: PMC8974871 DOI: 10.1002/mdc3.13412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023] Open
Abstract
We selected several "imaging pearls" presented during the Movement Disorder Society (MDS) Video Challenge for this review. While the event, as implicated by its name, was video-centered, we would like to emphasize the important role of imaging in making the correct diagnosis. We divided this anthology into two parts: genetic and acquired disorders. Genetic cases described herein were organized by the inheritance pattern and the focus was put on the imaging findings and differential diagnoses. Despite the overlapping phenotypes, certain described disorders have pathognomonic MRI brain findings that would provide either the "spot" diagnosis or result in further investigations leading to the diagnosis. Despite this, the diagnosis is often challenging with a broad differential diagnosis, and hallmark findings may be present for only a limited time.
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Affiliation(s)
- Diana A. Olszewska
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital—UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Sapna Rawal
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Conor Fearon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital—UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Paula Alcaide‐Leon
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Rick Stell
- Movement Disorders Unit, Perron Institute of Neurological Translational ScienceSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | | | - Tim Lynch
- Centre for Brain HealthDublin Neurological Institute at the Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical ScienceUniversity College DublinDublinIreland
| | - Tania Jawad
- Department of NeurologyThe Royal Free HospitalLondonUnited Kingdom
| | - Padmaja Vittal
- Northwestern Medicine Central Dupage HospitalNeurodegenerative Diseases CenterWinfieldIllinoisUSA
| | - Brandon Barton
- Rush University Medical CenterChicagoIllinoisUSA
- Parkinson's Disease Research, Education, and Clinical Care ConsortiumJesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Hiroaki Miyajima
- First Department of MedicineHamamatsu University School of MedicineHamamatsuJapan
| | | | | | - Rupam Borgohain
- Department of NeurologyNizam's Institute of Medical SciencesHyderabadIndia
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital—UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
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Paraskevas GP, Stefanou MI, Constantinides VC, Bakola E, Chondrogianni M, Giannopoulos S, Kararizou E, Boufidou F, Zompola C, Tsantzali I, Theodorou A, Palaiodimou L, Vikelis M, Lachanis S, Papathanasiou M, Bakirtzis C, Koutroulou I, Karapanayiotides T, Xiromerisiou G, Kapaki E, Tsivgoulis G. CADASIL in Greece: Mutational spectrum and clinical characteristics based on a systematic review and pooled analysis of published cases. Eur J Neurol 2021; 29:810-819. [PMID: 34761493 DOI: 10.1111/ene.15180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Differences have been noted in the clinical presentation and mutational spectrum of CADASIL among various geographical areas. The aim of the present study was to investigate the mode of clinical presentation and genetic mutations reported in Greece. METHODS After a systematic literature search, we performed a pooled analysis of all published CADASIL cases from Greece. RESULTS We identified 14 studies that reported data from 14 families comprising 54 patients. Migraine with aura was reported in 39%, ischemic cerebrovascular diseases in 68%, behavioral-psychiatric symptoms in 47% and cognitive decline in 60% of the patients. The mean (±SD) age of onset for migraine with aura, ischemic cerebrovascular diseases, behavioral-psychiatric symptoms and cognitive decline was 26.2 ± 8.7, 49.3 ± 14.6, 47.9 ± 9.4 and 42.9 ± 10.3, respectively; the mean age at disease onset and death was 34.6 ± 12.1 and 60.2 ± 11.2 years. With respect to reported mutations, mutations in exon 4 were the most frequently reported (61.5% of all families), with the R169C mutation being the most common (30.8% of all families and 50% of exon 4 mutations), followed by R182C mutation (15.4% of all families and 25% of exon 4 mutations). CONCLUSIONS The clinical presentation of CADASIL in Greece is in accordance with the phenotype encountered in Caucasian populations, but differs from the Asian phenotype, which is characterized by a lower prevalence of migraine and psychiatric symptoms. The genotype of Greek CADASIL pedigrees is similar to that of British pedigrees, exhibiting a high prevalence of exon 4 mutations, but differs from Italian and Asian populations, where mutations in exon 11 are frequently encountered.
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Affiliation(s)
- George P Paraskevas
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Ioanna Stefanou
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios C Constantinides
- First Department of Neurology, School of Medicine, "Eginition" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Chondrogianni
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Giannopoulos
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelia Kararizou
- First Department of Neurology, School of Medicine, "Eginition" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Fotini Boufidou
- First Department of Neurology, School of Medicine, "Eginition" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Zompola
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioanna Tsantzali
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Theodorou
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Matilda Papathanasiou
- Second Department of Radiology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christos Bakirtzis
- Second Department of Neurology, School of Medicine, "AHEPA" University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Koutroulou
- Second Department of Neurology, School of Medicine, "AHEPA" University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karapanayiotides
- Second Department of Neurology, School of Medicine, "AHEPA" University Hospital of Thessaloniki, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgia Xiromerisiou
- Department of Neurology, School of Medicine, School of Health Sciences, University Hospital of Larissa, University of Thessaly, Larissa, Greece
| | - Elisabeth Kapaki
- First Department of Neurology, School of Medicine, "Eginition" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, School of Medicine, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Figueiredo C, Fernandes M, Casimiro C, Santos M, Costa C. Internuclear ophthalmoplegia as an atypical presentation of lacunar stroke in CADASIL. J Thromb Thrombolysis 2021; 52:350-353. [PMID: 33387205 DOI: 10.1007/s11239-020-02359-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Carlos Figueiredo
- Neurology Department, Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal.
| | - Mariana Fernandes
- Neurology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisbon, Portugal
| | - Carlos Casimiro
- Neuroradiology Department, Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal
| | - Mariana Santos
- Neurology Department, Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal
| | - Cristina Costa
- Neurology Department, Hospital Prof. Dr. Fernando Fonseca, Amadora, Portugal
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An alternative mechanism of crossed vertical gaze palsy in unilateral mesodiencephalic infarction. Med Hypotheses 2020; 146:110372. [PMID: 33221135 DOI: 10.1016/j.mehy.2020.110372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/25/2020] [Accepted: 11/01/2020] [Indexed: 11/22/2022]
Abstract
Crossed vertical gaze palsy refers to a rare combination of elevation paresis in one eye and depression palsy in the fellow eye. It was once reported in a patient with unilateral infarction involving the mesodiencephalic junction, and was ascribed to selective disruption of the fibers projecting from the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF) to the oculomotor nuclear complex. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare cause of ophthalmoplegia and crossed vertical gaze palsy has not been described in this disorder. Our patient with a circumscribed acute infarction involving the left mesodiencephalic junction due to CADASIL showed both upward and downward gaze palsy in both eyes, but more marked depression paresis in the ipsilesional eye and more conspicuous elevation deficit in the contralesional eye, which was consistent with crossed vertical gaze palsy. We provide alternate explanation for this rare phenotype of vertical gaze palsy. Selective disruption of riMLF fibers may cause crossed vertical gaze palsy in unilateral mesodiencephalic lesion.
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Trifan G, Hillmann M, Testai FD. Acute Stroke as the Presenting Symptom of SARS-CoV-2 Infection in a Young Patient with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy. J Stroke Cerebrovasc Dis 2020; 29:105167. [PMID: 32912545 PMCID: PMC7369597 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 01/20/2023] Open
Affiliation(s)
- Gabriela Trifan
- University of Illinois at Chicago College of Medicine, Department of Neurology and Rehabilitation, 912 S. Wood Street, Chicago, 60612, United States.
| | - Maureen Hillmann
- University of Illinois at Chicago College of Medicine, Department of Neurology and Rehabilitation, 912 S. Wood Street, Chicago, 60612, United States.
| | - Fernando D Testai
- University of Illinois at Chicago College of Medicine, Department of Neurology and Rehabilitation, 912 S. Wood Street, Chicago, 60612, United States.
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Ungaro C, Sprovieri T. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL). Rare Dis 2020. [DOI: 10.5772/intechopen.87248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Cadasil. Neurologia 2017. [DOI: 10.1016/s1634-7072(17)85562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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10
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Hwang YT, Lakshmanan R, Davagnanam I, Thompson AGB, Lynch DS, Houlden H, Bajaj N, Eriksson SH, Bamiou DE, Warren JD. Brainstem phenotype of cathepsin A-related arteriopathy with strokes and leukoencephalopathy. Neurol Genet 2017; 3:e165. [PMID: 28702507 PMCID: PMC5499977 DOI: 10.1212/nxg.0000000000000165] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/12/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Yun Tae Hwang
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Rahul Lakshmanan
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Indran Davagnanam
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Andrew G B Thompson
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - David S Lynch
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Henry Houlden
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Nin Bajaj
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Sofia H Eriksson
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Doris-Eva Bamiou
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
| | - Jason D Warren
- Dementia Research Centre (Y.T.H., J.D.W.), Department of Neurodegenerative Disease (A.G.B.T.), Department of Molecular Neuroscience (D.S.L., H.H.), UCL Institute of Neurology, and UCL Ear Institute (D.-E.B.), University College London; Lysholm Department of Neuroradiology (R.L., I.D.) and Department of Clinical and Experimental Epilepsy (S.H.E.), National Hospital for Neurology and Neurosurgery, London; and Department of Neurology (N.B.), Queen's Medical Centre, Nottingham, United Kingdom
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Perneczky R, Tene O, Attems J, Giannakopoulos P, Ikram MA, Federico A, Sarazin M, Middleton LT. Is the time ripe for new diagnostic criteria of cognitive impairment due to cerebrovascular disease? Consensus report of the International Congress on Vascular Dementia working group. BMC Med 2016; 14:162. [PMID: 27806707 PMCID: PMC5093932 DOI: 10.1186/s12916-016-0719-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 10/14/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Long before Alzheimer's disease was established as the leading cause of dementia in old age, cerebrovascular lesions were known to cause cognitive deterioration and associated disability. Since the middle of the last century, different diagnostic concepts for vascular dementia and related syndromes were put forward, yet no widely accepted diagnostic consensus exists to date. DISCUSSION Several international efforts, reviewed herein, are ongoing to define cognitive impairment due to cerebrovascular disease in its different stages and subtypes. The role of biomarkers is also being discussed, including cerebrospinal fluid proteins, structural and functional brain imaging, and genetic markers. The influence of risk factors, such as diet, exercise and different comorbidities, is emphasised by population-based research, and lifestyle changes are considered for the treatment and prevention of dementia. CONCLUSION To improve the diagnosis and management of vascular cognitive impairment, further progress has to be made in understanding the relevant pathomechanisms, including shared mechanisms with Alzheimer's disease; bringing together fragmented research initiatives in coordinated international programs; testing if known risk factors are modifiable in prospective interventional studies; and defining the pre-dementia and pre-clinical stages in line with the concept of mild cognitive impairment due to Alzheimer's disease.
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Affiliation(s)
- Robert Perneczky
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, Charing Cross Hospital, St Dunstan's Road, W6 8RP, London, UK. .,Department of Psychiatry and Psychotherapy, Technische Universität München, Ismaninger Str. 22, 81675, München, Germany. .,Cognitive Impairment and Dementia Service, West London Mental Health NHS Trust, Lakeside Mental Health Unit, West Middlesex University Hospital, Twickenham Road, TW7 6FY, London, UK. .,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München, Nussbaumstr. 7, 80336, München, Germany.
| | - Oren Tene
- Department of Psychiatry, Tel Aviv Sourasky Medical Center, Haim Weizman St 6, Tel Aviv-Yafo, 64239, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, 69978, Israel
| | - Johannes Attems
- Institute of Neuroscience, Newcastle University, Campus for Ageing and Vitality, NE4 5PL, Newcastle upon Tyne, UK
| | - Panteleimon Giannakopoulos
- Department of Psychiatry, University of Geneva School of Medicine, 2 rue Verte, 1205, Geneva, Switzerland
| | - M Arfan Ikram
- Departments of Epidemiology, Radiology and Neurology, Erasmus MC, 's-Gravendijkwal 230, 3015, CE, Rotterdam, The Netherlands
| | - Antonio Federico
- Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Marie Sarazin
- Unit of Neurology of Memory and Language, Centre de Psychiatrie et Neurosciences, INSERM UMR S894, Centre Hospitalier Sainte Anne and Université Paris Descartes, Sorbonne Paris Cité, 75013, Paris, France
| | - Lefkos T Middleton
- Neuroepidemiology and Ageing Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, Charing Cross Hospital, St Dunstan's Road, W6 8RP, London, UK.
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Ayrignac X, Boutiere C, Carra-dalliere C, Labauge P. Posterior fossa involvement in the diagnosis of adult-onset inherited leukoencephalopathies. J Neurol 2016; 263:2361-2368. [DOI: 10.1007/s00415-016-8131-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 04/09/2016] [Accepted: 04/11/2016] [Indexed: 01/09/2023]
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14
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Labauge P, Ayrignac X, Carra-Dallière C, Menjot de Champfleur N. Leucodistrofie dell’adulto. Neurologia 2016. [DOI: 10.1016/s1634-7072(15)76144-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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CADASIL. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00041-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Visual System Involvement in CADASIL. J Stroke Cerebrovasc Dis 2013; 22:1377-84. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.03.032] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 03/18/2013] [Accepted: 03/29/2013] [Indexed: 01/23/2023] Open
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Characterisation of endothelin-1-induced intrastriatal lesions within the juvenile and adult rat brain using MRI and 31P MRS. Transl Stroke Res 2013; 4:351-67. [PMID: 24323302 DOI: 10.1007/s12975-013-0258-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 03/11/2013] [Accepted: 03/18/2013] [Indexed: 01/12/2023]
Abstract
Improved non-invasive magnetic resonance (MR) characterisation of in vivo models of focal ischaemic insults such as transient ischaemic attack (TIA) and perinatal arterial ischaemic stroke (AIS) may assist diagnosis, outcome prediction and treatment design. The classic middle cerebral artery occlusion (MCAO) model of ischaemic stroke is well documented in MR studies but generates extensive and complex lesions involving an acute inflammatory response and de-occlusion that immediately restores circulation. By contrast, intrastriatal microinjection of the potent vasoconstrictor, endothelin-1 (ET-1), induces a focal, reversible and low-flow ischaemia in the absence of a typical inflammatory response, which gradually restores blood flow over several hours and may be more relevant to TIA and AIS pathology. This study presents the first comprehensive longitudinal MR characterisation of the real-time anatomical [T1-weighted (T1-w)/T2-weighted (T2-w)], pathophysiological [apparent diffusion coefficient (ADC), cerebral blood volume, gadolinium contrast imaging of blood-brain barrier (BBB) integrity] and metabolic [phosphorus magnetic resonance spectroscopy (31P MRS)] evolution of a purely ischaemic ET-1-induced lesion within the juvenile and adult rat brain. ET-1-induced cytotoxic oedema was visualised on T2-w magnetic resonance imaging (MRI), inconsistent with the conventional notion that it cannot be detected using anatomical MRI. There was no immunohistochemical evidence of an acute inflammatory response or loss of BBB integrity, thus excluding a vasogenic oedema contribution to the pathology. Maximal T2-w intensity correlated with the lowest ADC value in both age groups, re-emphasising the purely ischaemic nature of the lesion and the absence of vasogenic oedema. Furthermore, extensive acute T1-w hypointensity was observed in the presence of cytotoxic oedema-induced T2-w changes, whereas other authors have shown that increased T1 values following MCAO reflect vasogenic oedema. Intriguingly, the lesion border exhibited hyperintensity on T2-w and ADC MRI at later time points, and the former may be a consequence of phagocytosis-induced fatty droplet deposition by macrophages detected immunohistochemically. In spite of a chronically reduced ADC, typically associated with ischaemia-induced energy failure, a 31P MRS-detectable reduction in the phosphocreatine (PCr) to gamma adenosine triphosphate (γATP) ratio was not observed at any time point in either age group, suggesting dissociation of tissue water diffusion and metabolic changes within the ET-1-induced lesion.
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Murray AD, Staff RT, McNeil CJ, Salarirad S, Phillips LH, Starr J, Deary IJ, Whalley LJ. Depressive symptoms in late life and cerebrovascular disease: the importance of intelligence and lesion location. Depress Anxiety 2013; 30:77-84. [PMID: 23165823 DOI: 10.1002/da.22022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 09/03/2012] [Accepted: 10/12/2012] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The influence of white matter lesions on depressive symptoms in healthy ageing populations remains unclear. In this study, we examined the relationship between depressive symptoms and magnetic resonance imaging (MRI) detected cerebrovascular disease in a normal population living independently in the community, and measured the influence of location of brain abnormalities, fluid intelligence, living alone, and sex. METHODS Prospective cohort: 497 community dwelling individuals all born in 1936, who took part in the Scottish Mental Survey of 1947, were followed up in 2000 and at biannual intervals in a longitudinal study of health and cognitive aging. Two hundred forty-four volunteered for brain MRI in 2004-2006. Suitable data were available in 219/244, of whom 115 were men. Brain hyperintensities in lobar white matter, basal ganglia , periventricular, and infratentorial regions were measured using Scheltens' scale. Depressed mood was assessed using the Hospital Anxiety and Depression Scale (HADS) on three biannual intervals. Relationships between Scheltens' scores, HADS-D scores, fluid intelligence, living alone, and sex were assessed using general linear modeling. RESULTS The main predictor of depressive symptom scores was poorer fluid intelligence (partial η(2) =0.023-0.028, P < .05). Ischemic change in the brainstem (partial η(2) = 0.026, P ≤.05) and basal ganglia (partial η(2) =0.018, P ≤ .05) also predicted HADS-D scores. There was no relationship with sex or living alone. CONCLUSIONS Hyperintensities in the brainstem and basal ganglia are associated with depressive symptoms. Higher fluid intelligence is associated with lower depressive symptoms in this normal, ageing population.
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Affiliation(s)
- Alison D Murray
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, Scotland, UK.
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20
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Román G, Pascual B. Contribution of Neuroimaging to the Diagnosis of Alzheimer’s Disease and Vascular Dementia. Arch Med Res 2012; 43:671-6. [DOI: 10.1016/j.arcmed.2012.10.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 10/25/2012] [Indexed: 01/05/2023]
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21
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Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leucoencephalopathy (CADASIL) revealed by Claude's syndrome. Rev Neurol (Paris) 2012; 168:384-6. [DOI: 10.1016/j.neurol.2011.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 08/05/2011] [Accepted: 08/30/2011] [Indexed: 11/23/2022]
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22
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Donnini I, Nannucci S, Valenti R, Pescini F, Bianchi S, Inzitari D, Pantoni L. Acetazolamide for the prophylaxis of migraine in CADASIL: a preliminary experience. J Headache Pain 2012; 13:299-302. [PMID: 22367627 PMCID: PMC3356473 DOI: 10.1007/s10194-012-0426-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 02/12/2012] [Indexed: 11/28/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited microangiopathy caused by NOTCH3 mutations. It is characterized by migraine, with or without aura, ischemic events, psychiatric and cognitive disturbances. There is no approved treatment for migraine prophylaxis in CADASIL, but acetazolamide has been anecdotally reported to be effective. We retrospectively reviewed our database of patients with a genetic diagnosis of CADASIL to identify how many of them were treated with acetazolamide for the prophylaxis of migraine. The efficacy and the tolerability of this treatment were checked looking at the clinic reports. Acetazolamide was prescribed in seven patients; the mean duration of treatment was 6 months, and the daily dose ranged from 125 to 500 mg. Three patients had a total and sustained remission, while in two patients a reduction in attacks and an improvement of the headache intensity were recorded. In one of these, acetazolamide was deliberately taken only during the migraine attack and the beneficial effect started 1 h after administration. In two patients, the drug did not produce any beneficial effect. Mild side effects were recorded in two patients. Our preliminary experience expands previous reports and confirms the possible efficacy of acetazolamide in CADASIL migraine. Based on these data, a randomized controlled trial seems worthy to be carried out to test the efficacy and safety of this drug.
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Affiliation(s)
- Ida Donnini
- Department of Neurological and Psychiatric Sciences, University of Florence, Largo Brambilla 3, Florence, Italy
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Patel B, Markus HS. Magnetic resonance imaging in cerebral small vessel disease and its use as a surrogate disease marker. Int J Stroke 2011; 6:47-59. [PMID: 21205241 DOI: 10.1111/j.1747-4949.2010.00552.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Cerebral small vessel disease is an important cause of vascular cognitive impairment and dementia. On brain imaging, discrete lacunar infarcts and/or more diffuse regions of white matter hyperintensities or leucoaraiosis are seen. Magnetic resonance imaging plays a crucial role in diagnosis, and advanced magnetic resonance imaging techniques are providing new information on disease mechanisms and offering potential as surrogate disease markers. Longitudinal studies have demonstrated detectable progression of lesion load over short time periods, and weak correlations with cognition. Stronger correlations with cognition have been found with diffusion tensor imaging, which is more sensitive to white matter tract structure, supporting a role for disconnection in the pathogenesis of cognitive impairment. Brain volume also consistently correlates with cognition in asymptomatic small vessel disease, sporadic small vessel disease, and Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy. Gradient echo magnetic resonance imaging identifies microbleeds in a significant proportion of patients with small vessel disease, although their role in clinical management remains to be determined. Surrogate markers to monitor disease progression and evaluate new therapies would have major clinical use. The greater sensitivity of diffusion tensor imaging parameters and brain volume to change, and the stronger correlation of these parameters with cognition, suggest that they may be more powerful surrogates. However, data from longitudinal and intervention studies are required to determine if this is indeed the case. In this systematic review, we describe the use of both conventional and advanced magnetic resonance imaging techniques in patient groups with the full spectrum of clinical small vessel disease, from normal populations with WMH to patients groups with lacunar stroke and dementia.
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Affiliation(s)
- Bhavini Patel
- Clinical Neuroscience, St George's University of London, London, UK
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Kruit MC, van Buchem MA, Launer LJ, Terwindt GM, Ferrari MD. Migraine is associated with an increased risk of deep white matter lesions, subclinical posterior circulation infarcts and brain iron accumulation: the population-based MRI CAMERA study. Cephalalgia 2011; 30:129-36. [PMID: 19515125 DOI: 10.1111/j.1468-2982.2009.01904.x] [Citation(s) in RCA: 248] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Previous studies have suggested that migraine is a risk factor for brain lesions, but methodological issues hampered drawing definite conclusions. Therefore, we initiated the magnetic resonance imaging (MRI) ‘CAMERA’ (Cerebral Abnormalities in Migraine, an Epidemiological Risk Analysis) study. We summarize our previously published results. A total of 295 migraineurs and 140 controls were randomly selected from a previously diagnosed population-based sample (n = 6039), who underwent an interview, physical examination and a brain MRI scan. Migraineurs, notably those with aura, had higher prevalence of subclinical infarcts in the posterior circulation [odds ratio (OR) 13.7; 95% confidence interval (CI) 1.7, 112]. Female migraineurs were at independent increased risk of white matter lesions (WMLs; OR 2.1; 95% CI 1.0, 4.1), and migraineurs had a higher prevalence of brainstem hyperintense lesions (4.4% vs. 0.7%, P = 0.04). We observed a higher lifetime prevalence of (frequent) syncope and orthostatic insufficiency in migraineurs; future research needs to clarify whether autonomic nervous system dysfunction could explain (part of) the increased risk of WMLs in female migraineurs. Finally, in migraineurs aged < 50 years, compared with controls, we found evidence of increased iron concentrations in putamen (P = 0.02), globus pallidus (P = 0.03) and red nucleus (P = 0.03). Higher risks in those with higher attack frequency or longer disease duration were found consistent with a causal relationship between migraine and lesions. This summary of our population-based data illustrates that migraine is associated with a significantly increased risk of brain lesions. Longitudinal studies are needed to assess whether these lesions are progressive and have relevant (long-term) functional correlates.
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Affiliation(s)
- M C Kruit
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
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25
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CADASIL. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10039-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a dominantly inherited small artery disease that leads to dementia and disability in mid-life. The clinical presentation of CADASIL is variable between and within affected families and is characterized by symptoms including migraine with aura, subcortical ischemic events, mood disturbances, apathy, and cognitive impairment. The mean age at onset of symptoms is 45 years, with variable duration of the disease ranging from 10 to 40 years. In 1996, linkage studies mapped and identified mutations in the NOTCH3 gene on chromosome 19 as causative in CADASIL. Head magnetic resonance imaging (MRI) is always abnormal in participants with NOTCH3 mutations after age 35. Magnetic resonance imaging shows on T2-weighted images or fluid attenuation inversion recovery (FLAIR) sequence, widespread areas of increased signal in the white matter associated with focal hyperintensities in basal ganglia, thalamus, and brainstem. The pathologic hallmark of CADASIL is the presence of electron-dense granules in the media of arterioles that can be identified by electron microscopic evaluation of skin biopsies.
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Affiliation(s)
- D Hervé
- Service de Neurologie, Centre de Référence des maladies Vasculaires rares du Cerveau et de l'Oeil (CERVCO), Hôpital Lariboisière, Paris, France.
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Cleves C, Friedman NR, Rothner AD, Hussain MS. Genetically confirmed CADASIL in a pediatric patient. Pediatrics 2010; 126:e1603-7. [PMID: 21078731 DOI: 10.1542/peds.2010-0714] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 17-year-old girl presented with migraine with prolonged aura and aura without headache. Neurologic examination was normal. Her mother, who did not have a history of migraine, developed right-face and -arm numbness at the age of 45. Evaluation revealed white matter changes consistent with CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy), and genetic testing showed a Notch3 gene mutation consistent with CADASIL. Our patient's MRI revealed white matter changes and the same Notch3 gene mutation. Low-dose aspirin was started in an attempt to prevent stroke. CADASIL is considered a degenerative disease of adult onset that leads to progressive neurologic deterioration. Onset of symptoms is in the third decade. Migraine, one of its most common manifestations, can develop in childhood. Evaluation for secondary causes is warranted in select pediatric patients who present with atypical migraine, when there is a family history of CADASIL or atypical patterns such as aura without headache, or in the presence of white matter abnormalities. The pathophysiology of CADASIL is poorly understood, and there is no proven effective therapy. Patients require genetic counseling and close follow-up. It is not known if interventions such as antiplatelet therapy are beneficial if instituted early in the course of the disease. Screening of family members at risk for CADASIL, even in the pediatric population, should be considered and offered to patients with CADASIL and their families. CADASIL has rarely been described in the pediatric population. This case report expands our current understanding of the disorder in children.
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Affiliation(s)
- Catalina Cleves
- Center for Pediatric Neurology, Neurological Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195, USA
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28
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Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is the most common heritable cause of stroke and vascular dementia in adults. Clinical and neuroimaging features resemble those of sporadic small-artery disease, although patients with CADASIL have an earlier age at onset of stroke events, an increased frequency of migraine with aura, and a slightly variable pattern of ischaemic white-matter lesions on brain MRI. NOTCH3 (Notch homolog 3), the gene involved in CADASIL, encodes a transmembrane receptor primarily expressed in systemic arterial smooth-muscle cells. Pathogenetic mutations alter the number of cysteine residues in the extracellular domain of NOTCH3, which accumulates in small arteries of affected individuals. Functional and imaging studies in cultured cells, genetically engineered mice, and patients with CADASIL have all provided insights into the molecular and vascular mechanisms underlying this disease. A recent multicentre trial in patients with cognitive impairment emphasises the feasibility of randomised trials in patients with CADASIL. In this Review, we summarise the current understanding of CADASIL, a devastating disorder that also serves as a model for the more common forms of subcortical ischaemic strokes and pure vascular dementia.
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Affiliation(s)
- Hugues Chabriat
- Service de Neurologie, Groupe Hospitalier Lariboisière-Fernand-Widal, Assistance Publique Hôpitaux de Paris, F-75010, Paris, France
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Guidetti D, Casali B, Mazzei RL, Dotti MT. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy. Clin Exp Hypertens 2009; 28:271-7. [PMID: 16833034 DOI: 10.1080/10641960600549223] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited autosomal dominant condition characterized by migrane, recurrent stroke, subcortical dementia, and pseudobulbar palsy. It begins with migraine with aura in -33% of patients. CADASIL is commonly overlooked or misdiagnosed owing to its recent identification. The pathological hallmark of angiopathy is the presence of multiple, small, deep cerebral infarcts, leucoencephalopathy, and nonatherorosclerotic, nonamyloid angiopathy involving mainly small, deep perforating cerebral arteries. Changes also are present in vascular smooth muscle cells and consist in the presence of granular osmiophilic material (GOM). The defective gene in CADASIL is Notch 3, which encodes a large transmembrane receptor. Magnetic resonance imaging shows high intensity signal lesions, often confluent, and areas of cystic degeneration of subcortical white matter and basal ganglia. Diagnostic strategies in CADASIL are matter of discussions because the electron microscopic demonstration of GOM was reported in 100% of symptomatic patients of French authors, but only in 45% of a British study. GOMs are not present in presymptomatic patients.
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Affiliation(s)
- D Guidetti
- Divisione di Neurologia, Azienda Ospedaliera Santa Maria Nuova, Reggio Emilia, Italy.
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30
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Genetica e malattie della sostanza bianca. Neurologia 2009. [DOI: 10.1016/s1634-7072(09)70510-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Acute vestibular syndrome in a patient with cerebral autosomal dominant leukoencephalopathy with subcortical infarcts and leukoencephalopathy (CADASIL). J Neurol Sci 2008; 271:211-3. [DOI: 10.1016/j.jns.2008.04.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Revised: 04/15/2008] [Accepted: 04/22/2008] [Indexed: 11/23/2022]
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Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited small-artery disease of mid-adulthood caused by mutations of the NOTCH3 gene. The disease is responsible for widespread white-matter lesions associated with lacunar infarctions in various subcortical areas. The disease is responsible for migraine with aura and ischemic strokes, and is associated with various degrees of cognitive impairment and with mood disturbances. CADASIL is considered as a unique model to investigate what is known as "subcortical ischemic vascular dementia." Recent data suggest that the number of lacunar infarctions and severity of cerebral atrophy are the main magnetic resonance imaging markers associated with cognitive and motor disabilities in this disorder. Mood disturbances are reported in 10% to 20% of patients, most often in association with cognitive alterations. Their exact origin remains unknown; the presence of ischemic lesions within the basal ganglia or the frontal white matter may promote the occurrence of these symptoms. Further studies are needed to better understand the relationships between cerebral lesions and both cognitive and psychiatric symptoms in this small-vessel disease of the brain.
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Affiliation(s)
- Hugues Chabriat
- Department of Neurology, Hopital Lariboisière, Université Paris VII, Denis Diderot, Paris, France.
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Mourad A, Levasseur M, Bousser MG, Chabriat H. Formes pauci symptomatiques de CADASIL après 60 ans. Rev Neurol (Paris) 2006; 162:827-31. [PMID: 17028543 DOI: 10.1016/s0035-3787(06)75085-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION CADASIL is a hereditary cerebral arteriopathy leading to progressive disability and dementia usually observed at 60 years. OBSERVATION We report four patients aged>60 years with typical Notch3 mutations leading to CADASIL who did not have dementia or disability. Three of them presented with only transient neurological manifestations. MRI results showed extensive hyperintense signals in the white-matter on T2-weighted images contrasting with very few lacunar infarcts. CONCLUSION These observations suggest that silent or symptomatic infarcts, which were rare in the present cases may be responsible for the clinical severity in this disorder.
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Affiliation(s)
- A Mourad
- Service de Neurologie CHG, Place du Général Leclerc, Orsay
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Razvi SSM, Bone I. Single gene disorders causing ischaemic stroke. J Neurol 2006; 253:685-700. [PMID: 16807686 DOI: 10.1007/s00415-006-0048-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2005] [Revised: 08/04/2005] [Accepted: 09/23/2005] [Indexed: 10/24/2022]
Abstract
Stroke is the third most common cause of death and the leading cause of long-term neurological disability in the world. Conventional vascular risk factors for stroke contribute approximately to only forty to fifty percent of stroke risk. Genetic factors may therefore contribute to a significant proportion of stroke and may be polygenic, monogenic or multi-factorial. Monogenic (single gene) disorders may potentially account for approximately one percent of all ischaemic stroke. Monogenic stroke disorders include conditions such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL) and hereditary endotheliopathy, retinopathy, nephropathy and stroke (HERNS). In addition, other monogenic conditions such as sickle cell and Fabry disease also lead to stroke. These monogenic disorders cause either small vessel or large vessel stroke (or a combination of both) and serve as useful models for understanding and studying conventional stroke and cerebrovascular disease and its accompaniments such as vascular dementia.
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Affiliation(s)
- Saif S M Razvi
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, 1345 Govan Road, Glasgow G51 4TF, UK
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Macrì MA, Colonnese C, Garreffa G, Fattapposta F, Restuccia R, Bianco F, Labruna L, Maraviglia B. A chemical shift imaging study on regional metabolite distribution in a CADASIL family. Magn Reson Imaging 2006; 24:443-7. [PMID: 16677951 DOI: 10.1016/j.mri.2005.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2005] [Accepted: 11/21/2005] [Indexed: 11/20/2022]
Abstract
A chemical shift imaging (CSI) study was performed to directly assess relative concentrations of N-acetylaspartate (NAA), Cho and Cr metabolites in normal- and abnormal-appearing brain tissue of asymptomatic and symptomatic members of a single family with a neuropathologic, genetic and electrophysiological confirmed diagnosis of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. The aim of the investigation was to evaluate clinical findings and metabolite abnormalities as early appearance of axonal injury in this syndrome. The main findings related statistically significant decreases in the mean metabolite ratios for NAA/Cr, NAA/Cho and Cho/Cr in the anterior parts in comparison with the posterior parts of the centrum semiovale in symptomatic and asymptomatic patients. The effect was considerably greater in the symptomatic patients, indicating a strong correlation between CSI and pathology results. No differences were found between the two areas in the control group. Although lactate signals were hardly detectable in individual spectra, there was a trend toward increased Lac/Cr values in the anterior parts with respect to the posterior parts in the patient group, with the effect particularly evident in the asymptomatic subjects with the gene mutation.
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Affiliation(s)
- Maria Antonietta Macrì
- Dipartimento di Medicina Sperimentale e Patologia, Università La Sapienza, 00185 Roma, Italy
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Ishiko A, Shimizu A, Nagata E, Ohta K, Tanaka M. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephaloapthy (CADASIL). Am J Dermatopathol 2005; 27:131-4. [PMID: 15798438 DOI: 10.1097/01.dad.0000136691.96212.ec] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebrovascular disease characterized by recurrent subcortical ischemic strokes starting in the third or fourth decade as a result of mutations in the Notch3 gene. Granular osmiophilic material (GOM) deposition around the vascular smooth muscle cells is a specific feature and electron microscopic observations of skin biopsies are useful for this diagnosis. A 39-year-old female with dizziness, abnormal visual fields, and hemiplegia, and a 42-year-old male with tinnitus and dizziness, were suspected of suffering from CADASIL based on MRI findings. Both cases were shown to have characteristic deposits of GOM, 200 to 800 nm in diameter, around the vascular smooth muscle cells of small arteries in the deep dermis, and thus the diagnoses of CADASIL were made, although there was no family history of cerebrovascular disorders or dementia. Dermatologists should be aware of these ultra-structural findings because this disease may occur sporadically and might be more common than initially thought.
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Affiliation(s)
- Akira Ishiko
- Department of Dermatology, Keio University School of Medicine, Tokyo, Japan.
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37
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Affiliation(s)
- S Stefanizzi
- Service de Neurologie, Hôpital Delafontaine, Saint Denis
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Wilder-Smith E, Shen Y, Ng YK, Yu GX, Chew NK, Tan CT, Wong MC. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) in a Chinese family: clinical, radiological and skin biopsy features. J Clin Neurosci 2004; 11:304-7. [PMID: 14975424 DOI: 10.1016/j.jocn.2003.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2003] [Accepted: 05/23/2003] [Indexed: 10/26/2022]
Abstract
We describe the clinical, radiological, genetic and skin biopsy findings of the first Chinese family with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Of the 43-member family tree extending over three generations, eight had typical clinical features of CADASIL with recurrent ischemic stroke. In the three surviving affected family members, brain MRI showed extensive leukoaraiosis. Genotyping revealed heterozygous C to T mutation at nucleotide 406 in exon 3. Unusual clinical features were cerebellar infarction as a presenting complaint and a late age of onset with mild symptoms at age 69. A novel finding is the suggestion of a direct correlation between clinical disease severity and the quantity of ultrastructural pathognomonic granular osmophilic material (GOM) seen on skin biopsy.
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Affiliation(s)
- E Wilder-Smith
- Division of Neurology, National University of Singapore, Singapore.
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Chabriat H, Joutel A, Vahedi K, Tournier-Lasserve E, Bousser M. CADASIL: Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy. Stroke 2004. [DOI: 10.1016/b0-44-306600-0/50038-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Vascular dementia (VaD) includes several different vascular mechanisms and changes in the brain. Among VaD, CADASIL is an inherited angiopathy caused by mutations in the Notch3 gene. The pathological hallmark of CADASIL is a granular osmiophilic material deposit (GOM) that is not only found in the brain, but also in the peripheral vascular tree. Consequently, a window into the brain was opened from a strictly neurological disease with tremendous consequences thanks to a skin biopsy. The latter was and continues to be used as a diagnostic tool for CADASIL, despite an immunohistochemical test that is now available. The skin biopsy first used as a diagnostic tool revealed the existence of numerous other VaDs presenting systemic vascular changes. Later, skin biopsy became a research tool, and a morphological skin vessel change classification was proposed on 300 patients. Interestingly, similar skin vessel lesions appear to be related to the same biological modifications. In addition, an early destruction of the medial muscle cells was noticed in 74% of cases. Because vascular smooth muscle cells secrete a powerful endothelial permeability factor (VEGF), their destruction could lead to a decrease in vascular permeability. Cocultures of endothelial cells with vascular muscle cells showed that their presence doubled vascular permeability. Thus, alteration or the loss of vascular muscle cells likely results in hypopermeability, in addition to vessel wall hypotonia and a watershed hypoperfusion. The wealth of information brought forth by knowledge of CADASIL provided new tools for research and clues for understanding the consequences of vascular impairments in dementia.
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Affiliation(s)
- Marie-Magdeleine Ruchoux
- Department of Neuropathology, Faculté de Médecine de Lille, Hôpital Roger Salengro, CHRU Lille, 59037 Lille, France.
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Manabe Y, Murakami T, Iwatsuki K, Narai H, Warita H, Hayashi T, Shoji M, Imai Y, Abe K. Nocturnal blood pressure dip in CADASIL. J Neurol Sci 2001; 193:13-6. [PMID: 11718744 DOI: 10.1016/s0022-510x(01)00636-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The influence of a nocturnal blood pressure dip on cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) has not yet been clarified. We attempted to examine a correlation with the nocturnal blood pressure dip and CADASIL. We monitored circadian blood pressure patterns by the use of a portable blood pressure monitoring device in five patients with CADASIL and 10 age- and sex-matched control subjects. Based on nocturnal fall in mean arterial blood pressure (MABP), we classified patients into extreme dippers (nocturnal reduction of MABP > or =20%), dippers (> or =10% but <20%), nondippers (<10% but > or =0%), and inverted dippers (<0%). Three patients revealed non-dipper and two inverted dipper. Nighttime MABP fall was significantly lower in patients compared with control subjects (P<0.01). This study suggests that a lower nocturnal blood pressure fall may be partly associated with incidence and/or worsening of deep white matter lesions in CADASIL.
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Affiliation(s)
- Y Manabe
- Department of Neurology, Graduate School of Medicine and Dentistry, Okayama University, 2-5-1 Shikata-cho, 700-8558, Okayama, Japan.
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Coulthard A, Blank SC, Bushby K, Kalaria RN, Burn DJ. Distribution of cranial MRI abnormalities in patients with symptomatic and subclinical CADASIL. Br J Radiol 2000; 73:256-65. [PMID: 10817040 DOI: 10.1259/bjr.73.867.10817040] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare, inherited cause of early stroke and dementia, with a poor prognosis. This study was performed to clarify lesion appearance and pattern of lesion distribution in CADASIL. 20 members of a single family were tested for the CADASIL gene mutation and studied with cranial MRI. Scans were evaluated for lesion load and pattern of lesion distribution. 19 patients had cranial MRI, of whom 11 had normal MRI scans, were clinically unaffected and tested negative for the CADASIL gene mutation. The remaining eight patients had abnormal cranial MRI scans: seven patients were positive for the CADASIL gene mutation and one (untested) patient was severely clinically affected. Three of the patients who tested positive for the CADASIL gene mutation were clinically unaffected at the time of imaging. All eight patients with abnormal cranial MRI had subcortical white matter abnormalities, mostly in frontal and temporal lobes. Lesions involving the corpus callosum were present on sagittal T2 weighted images in four of five clinically affected and one of three clinically unaffected patients. Lesions involving the deep grey nuclei and the brain stem were common. On T1 weighted images, lesions were either poorly defined (confluent white matter hypointensity) or well defined (cystic infarcts or enlarged perivascular spaces). Atrophy was infrequent. Familiarity with the range of cranial MRI appearances may aid diagnosis of CADASIL. Recognition of cranial imaging features in asymptomatic CADASIL patients could prompt earlier diagnosis.
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Affiliation(s)
- A Coulthard
- Department of Radiology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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