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Pan AP, Potter T, Bako A, Tannous J, Seshadri S, McCullough LD, Vahidy FS. Lifelong cerebrovascular disease burden among CADASIL patients: analysis from a global health research network. Front Neurol 2023; 14:1203985. [PMID: 37521283 PMCID: PMC10375407 DOI: 10.3389/fneur.2023.1203985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Data reporting on patients with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) within the United States population is limited. We sought to evaluate the overt cerebrovascular disease burden among patients with CADASIL. Methods Harmonized electronic medical records were extracted from the TriNetX global health research network. CADASIL patients were identified using diagnostic codes and those with/without history of documented stroke sub-types (ischemic stroke [IS], intracerebral hemorrhage [ICH], subarachnoid hemorrhage [SAH] and transient ischemic attack [TIA]) were compared. Adjusted odds ratios (OR) and 95% confidence intervals (CI) of stroke incidence and mortality associated with sex were computed. Results Between September 2018 and April 2020, 914 CADASIL patients were identified (median [IQR] age: 60 [50-69], 61.3% females); of whom 596 (65.2%) had documented cerebrovascular events (i.e., CADASIL-Stroke patients). Among CADASIL-Stroke patients, 89.4% experienced an IS, co-existing with TIAs in 27.7% and hemorrhagic strokes in 6.2%; initial stroke events occurred ≤65 years of age in 71% of patients. CADASIL-Stroke patients (vs. CADASIL-non-Stroke) had higher cardiovascular and neurological (migraines, cognitive impairment, epilepsy/seizures, mood disorders) burden. In age- and comorbidity-adjusted models, males had higher associated risk of stroke onset (OR: 1.37, CI: 1.01-1.86). Mortality risk was higher for males (OR: 2.72, CI: 1.53-4.84). Discussion Early screening and targeted treatment strategies are warranted to help CADASIL patients with symptom management and risk mitigation.
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Affiliation(s)
- Alan P. Pan
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
| | - Thomas Potter
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Abdulaziz Bako
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Jonika Tannous
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, University of Texas Health Science Center, San Antonio, TX, United States
| | - Louise D. McCullough
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center, Houston, TX, United States
| | - Farhaan S. Vahidy
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, United States
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2
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Servito M, Gill I, Durbin J, Ghasemlou N, Popov AF, Stephen CD, El-Diasty M. Management of Coronary Artery Disease in CADASIL Patients: Review of Current Literature. Medicina (B Aires) 2023; 59:medicina59030586. [PMID: 36984587 PMCID: PMC10059795 DOI: 10.3390/medicina59030586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/27/2023] [Accepted: 03/06/2023] [Indexed: 03/19/2023] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common heritable form of vascular dementia in adults. It is well-established that CADASIL results in neurocognitive dysfunction and mood disturbance. There is also cumulative evidence that CADASIL patients are more susceptible to ischemic heart disease. The aim of this study is to review the current literature regarding the incidence of coronary artery disease in CADASIL patients with a focus on the various management options and the clinical challenges associated with each of these treatment strategies. We conducted a literature search using Cochrane, MEDLINE, and EMBASE for papers that reported the occurrence of coronary artery disease in patients with CADASIL. We supplemented the search with a manual search in Google Scholar. Only case reports, case series, and original articles were included. The search resulted in six reports indicating the association between coronary artery disease and CADASIL and its management. Evidence suggests that extracranial manifestations of CADASIL may include coronary artery disease, presenting as a more extensive burden of disease in younger patients. Surgical and percutaneous revascularization strategies are feasible, but the incidence of peri-procedural stroke remains significant and should be weighed against the potential benefit derived from either of these strategies. A multidisciplinary approach to therapy, with perspectives from neurologists, cardiologists, and cardiac surgeons, is needed to provide the appropriate treatment to the CADASIL patient with severe coronary artery disease. Future studies should be directed toward the development of targeted therapies that may help with the early detection and prevention of disease progress in these patients.
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Affiliation(s)
- Maria Servito
- Department of Cardiac Surgery, University of Manitoba, Winnipeg, MB R2H 2A6, Canada
| | - Isha Gill
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON K7L 2V7, Canada
| | - Joshua Durbin
- Division of Cardiology, Department of Medicine, Queen’s University, Kingston, ON K7L 2V7, Canada
| | - Nader Ghasemlou
- Department of Anaesthesiology, Queen’s University, Kingston, ON K7L 2V7, Canada
| | - Aron-Frederik Popov
- Department of Cardiothoracic Surgery, Helios Clinic, 53721 Siegburg, Germany
- Correspondence:
| | - Christopher D. Stephen
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mohammad El-Diasty
- Division of Cardiac Surgery, Department of Surgery, Queen’s University, Kingston, ON K7L 2V7, Canada
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3
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Jia X, Ling C, Li Y, Zhang J, Li Z, Jia X, Wang DJJ, Zhang Z, Yuan Y, Yang Q. Sex differences in frontotemporal atrophy in CADASIL revealed by 7-Tesla MRI. Neuroimage Clin 2023; 37:103298. [PMID: 36577270 DOI: 10.1016/j.nicl.2022.103298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Brain damage caused by small vessel disease (SVD) differs between males and females. We aimed to examine the pure sex-specific neuroanatomical mechanisms of SVD adjusted for voxel-based expected effects of age and sex on healthy brain volume. Thirty-one female and 32 male genetic SVD (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, CADASIL) patients and 55 sex- and age-matched healthy controls (HCs) underwent 7-Tesla MRI examinations. Voxel-based W-score maps were calculated from volumes and deformations of brain tissues, controlling for the expected effects of age and sex in HCs. Significant cognitive declines in working memory and executive function were identified in male CADASIL patients compared to female patients. Greater gray matter (GM) atrophy was found in the bilateral orbitofrontal cortex (OFC), left anterior cingulate cortex (ACC), left entorhinal cortex (EC), and right temporooccipital cortex in male CADASIL patients than in females. Working memory was associated with volumes in the right OFC specific to female CADASIL patients, whereas visuospatial ability was associated with the right hOcl (primary visual area, BA 17) volume specific to males. The current findings indicate that sex affects the pathogenesis of CADASIL, ranging from differences in neuroanatomy to those in behavioral performance, which may facilitate the development of more effective sex-specific therapeutic strategies for CADASIL and SVD.
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Affiliation(s)
- Xiuqin Jia
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; Key Lab of Medical Engineering for Cardiovascular Disease, Ministry of Education, China
| | - Chen Ling
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Yingying Li
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Jinyuan Zhang
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, 15 Datun Road, Beijing 100101, China
| | - Zhixin Li
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, 15 Datun Road, Beijing 100101, China
| | - Xuejia Jia
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Danny J J Wang
- Lab of FMRI Technology (LOFT), Mark & Mary Stevens Neuroimaging and Informatics Institute Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Zihao Zhang
- State Key Laboratory of Brain and Cognitive Science, Institute of Biophysics, Chinese Academy of Sciences, 15 Datun Road, Beijing 100101, China; Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China.
| | - Yun Yuan
- Department of Neurology, Peking University First Hospital, Beijing 100034, China.
| | - Qi Yang
- Department of Radiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China; Key Lab of Medical Engineering for Cardiovascular Disease, Ministry of Education, China; Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, China.
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Dupé C, Guey S, Biard L, Dieng S, Lebenberg J, Grosset L, Alili N, Hervé D, Tournier-Lasserve E, Jouvent E, Chevret S, Chabriat H. Phenotypic variability in 446 CADASIL patients: Impact of NOTCH3 gene mutation location in addition to the effects of age, sex and vascular risk factors. J Cereb Blood Flow Metab 2023; 43:153-166. [PMID: 36254369 PMCID: PMC9875352 DOI: 10.1177/0271678x221126280] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The recent discovery that the prevalence of cysteine mutations in the NOTCH3 gene responsible for CADASIL was more than 100 times higher in the general population than that estimated in patients highlighted that the mutation location in EGFr-like-domains of the NOTCH3 receptor could have a major effect on the phenotype of the disease. The exact impact of such mutations locations on the multiple facets of the disease has not been fully evaluated. We aimed to describe the phenotypic spectrum of a large population of CADASIL patients and to investigate how this mutation location influenced various clinical and imaging features of the disease. Both a supervised and a non-supervised approach were used for analysis. The results confirmed that the mutation location is strongly related to clinical severity and showed that this effect is mainly driven by a different development of the most damaging ischemic tissue lesions at cerebral level. These effects were detected in addition to those of aging, male sex, hypertension and hypercholesterolemia. The exact mechanisms relating the location of mutations along the NOTCH3 receptor, the amount or properties of the resulting NOTCH3 products accumulating in the vessel wall, and their final consequences at cerebral level remain to be determined.
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Affiliation(s)
- Charlotte Dupé
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France.,UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
| | - Stéphanie Guey
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France.,UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
| | - Lucie Biard
- ECSTRRA Team, UMR-S 1153, Université Paris Cité, INSERM, Paris, France
| | - Sokhna Dieng
- ECSTRRA Team, UMR-S 1153, Université Paris Cité, INSERM, Paris, France
| | - Jessica Lebenberg
- UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
| | - Lina Grosset
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France
| | - Nassira Alili
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France
| | - Dominique Hervé
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France
| | | | - Eric Jouvent
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France.,UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
| | - Sylvie Chevret
- ECSTRRA Team, UMR-S 1153, Université Paris Cité, INSERM, Paris, France
| | - Hugues Chabriat
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France.,UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
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5
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Antiplatelets and Vascular Dementia: A Systematic Review. J Aging Res 2022; 2022:9780067. [PMID: 36245899 PMCID: PMC9553722 DOI: 10.1155/2022/9780067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/22/2022] [Indexed: 12/02/2022] Open
Abstract
Vascular dementia (VD) is a neurocognitive disorder whose precise definition is still up for debate. VD generally refers to dementia that is primarily caused by cerebrovascular disease or impaired cerebral blood flow. It is a subset of vascular cognitive impairment, a class of diseases that relate any cerebrovascular injury as a causal or correlating factor for cognitive decline, most commonly seen in the elderly. Patients who present with both cognitive impairment and clinical or radiologic indications of cerebrovascular pathology should have vascular risk factors, particularly hypertension, examined and treated. While these strategies may be more effective at avoiding dementia than at ameliorating it, there is a compelling case for intensive secondary stroke prevention in these patients. Repeated stroke is related to an increased chance of cognitive decline, and poststroke dementia is connected with an increased risk of death. In general, most physicians follow recommendations for secondary stroke prevention in patients with VD, which can be accomplished by the use of antithrombotic medicines such as antiplatelets (aspirin, clopidogrel, ticlopidine, cilostazol, etc.). In individuals with a high risk of atherosclerosis and those with documented symptomatic cerebrovascular illness, antiplatelets treatment lowers the risk of stroke. While this therapy strategy of prevention and rigorous risk management has a compelling justification, there is only limited and indirect data to support it. The following systematic review examines the role of antiplatelets in the management of vascular dementia in published clinical trials and studies and comments on the current evidence available to support their use and highlights the need for further study.
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Hack RJ, Cerfontaine MN, Gravesteijn G, Tap S, Hafkemeijer A, van der Grond J, Witjes-Ané MN, Baas F, Rutten JW, Lesnik Oberstein SA. Effect of
NOTCH3
EGFr Group, Sex, and Cardiovascular Risk Factors on CADASIL Clinical and Neuroimaging Outcomes. Stroke 2022; 53:3133-3144. [PMID: 35862191 PMCID: PMC9508953 DOI: 10.1161/strokeaha.122.039325] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A retrospective study has shown that EGFr (epidermal growth factor–like repeat) group in the NOTCH3 gene is an important cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) disease modifier of age at first stroke and white matter hyperintensity (WMH) volume. No study has yet assessed the effect of other known CADASIL modifiers, that is, cardiovascular risk factors and sex, in the context of NOTCH3 EGFr group. In this study, we determined the relative disease-modifying effects of NOTCH3 EGFr group, sex and cardiovascular risk factor on disease severity in the first genotype-driven, large prospective CADASIL cohort study, using a comprehensive battery of CADASIL clinical outcomes and neuroimaging markers.
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Affiliation(s)
- Remco J. Hack
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Minne N. Cerfontaine
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Gido Gravesteijn
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Stephan Tap
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Anne Hafkemeijer
- Department of Radiology, Leiden University Medical Center, the Netherlands. (A.H., J.v.d.G.)
- Institute of Psychology, Leiden University, the Netherlands. (A.H.)
- Leiden Institute for Brain and Cognition, Leiden University, the Netherlands. (A.H.)
| | - Jeroen van der Grond
- Department of Radiology, Leiden University Medical Center, the Netherlands. (A.H., J.v.d.G.)
| | - Marie-Noëlle Witjes-Ané
- Department of Geriatrics and Psychiatrics, Leiden University Medical Center, the Netherlands. (M.N.W.-A.)
| | - Frank Baas
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Julie W. Rutten
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
| | - Saskia A.J. Lesnik Oberstein
- Department of Clinical Genetics, Leiden University Medical Center, the Netherlands. (R.J.H., M.N.C., G.G., S.T., F.B., J.W.R., S.A.J.L.O.)
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7
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Lebenberg J, Guichard JP, Guillonnet A, Hervé D, Alili N, Taleb A, Dias-Gastellier N, Chabriat H, Jouvent E. The Epidermal Growth Factor Domain of the Mutation Does Not Appear to Influence Disease Progression in CADASIL When Brain Volume and Sex Are Taken into Account. AJNR Am J Neuroradiol 2022; 43:715-720. [PMID: 35487587 PMCID: PMC9089269 DOI: 10.3174/ajnr.a7499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE By studying the evolution of brain volume across the life span in male and female patients, we aimed to understand how sex, brain volume, and the epidermal growth factor repeat domain of the mutation, the 3 major determinants of disability in CADASIL, interact in driving disease evolution. MATERIALS AND METHODS We used validated methods to model the evolution of normalized brain volume with age in male and female patients using nonparametric regression in a large, monocentric cohort with prospectively collected clinical and high-resolution MR imaging data. We used k-means clustering to test for the presence of different clinical course profiles. RESULTS We included 229 patients (mean age, 53 [SD, 12] years; 130 women). Brain volume was larger in women (mean size, 1024 [SD, 62] cm3 versus 979 [SD, 50] cm3; P < .001) and decreased regularly. In men, the relationship between brain volume and age unexpectedly suggested an increase in brain volume around midlife. Cluster analyses showed that this finding was related to the presence of a group of older male patients with milder symptoms and larger brain volumes, similar to findings of age-matched women. This group did not show specific epidermal growth factor repeat domain distribution. CONCLUSIONS Our results demonstrate a detrimental effect of male sex on brain volume throughout life in CADASIL. We identified a subgroup of male patients whose brain volume and clinical outcomes were similar to those of age-matched women. They did not have a specific distribution of the epidermal growth factor repeat domain, suggesting that yet-unidentified predictors may interact with sex and brain volume in driving disease evolution.
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Affiliation(s)
- J Lebenberg
- the Centre de Neurologie Vasculaire Translationel (J.L., D.H., N.A., A.T., N.D.-G., H.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France; L'Institut National de la Santé et de la RechercheMédicale INSERM U1141, Université Paris Cité, Paris, France
- Federation Hospitalo-Universitaire NeuroVasc (J.L., N.D.-G., D.H., H.C., E.J.), Paris, France
| | | | | | - D Hervé
- the Centre de Neurologie Vasculaire Translationel (J.L., D.H., N.A., A.T., N.D.-G., H.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France; L'Institut National de la Santé et de la RechercheMédicale INSERM U1141, Université Paris Cité, Paris, France
- Federation Hospitalo-Universitaire NeuroVasc (J.L., N.D.-G., D.H., H.C., E.J.), Paris, France
| | - N Alili
- the Centre de Neurologie Vasculaire Translationel (J.L., D.H., N.A., A.T., N.D.-G., H.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France; L'Institut National de la Santé et de la RechercheMédicale INSERM U1141, Université Paris Cité, Paris, France
| | - A Taleb
- the Centre de Neurologie Vasculaire Translationel (J.L., D.H., N.A., A.T., N.D.-G., H.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France; L'Institut National de la Santé et de la RechercheMédicale INSERM U1141, Université Paris Cité, Paris, France
| | - N Dias-Gastellier
- the Centre de Neurologie Vasculaire Translationel (J.L., D.H., N.A., A.T., N.D.-G., H.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France; L'Institut National de la Santé et de la RechercheMédicale INSERM U1141, Université Paris Cité, Paris, France
- Federation Hospitalo-Universitaire NeuroVasc (J.L., N.D.-G., D.H., H.C., E.J.), Paris, France
| | - H Chabriat
- the Centre de Neurologie Vasculaire Translationel (J.L., D.H., N.A., A.T., N.D.-G., H.C.), Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiere, Paris, France; L'Institut National de la Santé et de la RechercheMédicale INSERM U1141, Université Paris Cité, Paris, France
- Federation Hospitalo-Universitaire NeuroVasc (J.L., N.D.-G., D.H., H.C., E.J.), Paris, France
| | - E Jouvent
- From the Department of Neurology (E.J.)
- Federation Hospitalo-Universitaire NeuroVasc (J.L., N.D.-G., D.H., H.C., E.J.), Paris, France
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Jacobs HI, Schoemaker D, Torrico-Teave H, Zuluaga Y, Velilla-Jimenez L, Ospina-Villegas C, Lopera F, Arboleda-Velasquez JF, Quiroz YT. Specific Abnormalities in White Matter Pathways as Interface to Small Vessels Disease and Cognition in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy Individuals. Brain Connect 2022; 12:52-60. [PMID: 33980027 PMCID: PMC8867102 DOI: 10.1089/brain.2020.0980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is characterized by leukoencephalopathy leading to cognitive impairment. Subtle cognitive deficits can be observed early in the course of the disease, before the occurrence of the first stroke. Therefore, markers that can predict disease progression at this early stage, when interventions are likely to alter disease course, are needed. We aimed to examine the biological cascade of microstructural and macrostructural white matter (WM) abnormalities underlying cognitive deficits in CADASIL. Methods: We examined 20 nondemented CADASIL mutation carriers and 23 noncarriers who underwent neuropsychological evaluation and magnetic resonance imaging. Using probabilistic tractography of key WM tracts, we examined group differences in diffusivity measures and WM hyperintensity volume. Successive mediation models examined whether tract-specific WM abnormalities mediated subtle cognitive differences between CADASIL mutation carriers and noncarriers. Results: The largest effect size differentiating the two groups was observed for left superior longitudinal fasciculus-temporal (SLFt) diffusivity (Cohen's f = 0.49). No group differences were observed with a global diffusion measure. These specific microstructural differences in the SLFt were associated with higher WM hyperintensities burden, and subtle executive deficits in CADASIL mutation carriers. Discussion: Worse diffusivity in the left SLFt is related to greater severity of small vessel disease and worse executive functioning in the asymptomatic stage of the disease. Worse diffusivity of the left SLFt may potentially hold promise as an indicator of disease progression. Impact statement Diffusion tensor imaging outperforms conventional imaging of subcortical small vessel disease as a potential marker of future disease progression. Here we identified the left superior longitudinal temporal fasciculus as a critical white matter fiber bundle, of which worse diffusivity can link presence of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy mutations to greater severity of small vessel disease and worse executive functioning in asymptomatic stages of the disease. This tract may hold promise and deserves further examination as an early indicator of disease progression.
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Affiliation(s)
- Heidi I.L. Jacobs
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Gordon Center for Medical Imaging, Boston, Massachusetts, USA.,Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, The Netherlands
| | - Dorothee Schoemaker
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hei Torrico-Teave
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Yesica Zuluaga
- Grupo Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | | | | | - Francisco Lopera
- Grupo Neurociencias de Antioquia, Universidad de Antioquia, Medellín, Colombia
| | - Joseph F. Arboleda-Velasquez
- Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Yakeel T. Quiroz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Address correspondence to: Yakeel T. Quiroz, Department of Psychiatry and Neurology, Harvard Medical School, Massachusetts General Hospital, 100 1st Avenue, Building 39, Suite 101, Charlestown, MA 02129, USA
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9
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Jiménez-Sánchez L, Hamilton OKL, Clancy U, Backhouse EV, Stewart CR, Stringer MS, Doubal FN, Wardlaw JM. Sex Differences in Cerebral Small Vessel Disease: A Systematic Review and Meta-Analysis. Front Neurol 2021; 12:756887. [PMID: 34777227 PMCID: PMC8581736 DOI: 10.3389/fneur.2021.756887] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/04/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Cerebral small vessel disease (SVD) is a common cause of stroke, mild cognitive impairment, dementia and physical impairments. Differences in SVD incidence or severity between males and females are unknown. We assessed sex differences in SVD by assessing the male-to-female ratio (M:F) of recruited participants and incidence of SVD, risk factor presence, distribution, and severity of SVD features. Methods: We assessed four recent systematic reviews on SVD and performed a supplementary search of MEDLINE to identify studies reporting M:F ratio in covert, stroke, or cognitive SVD presentations (registered protocol: CRD42020193995). We meta-analyzed differences in sex ratios across time, countries, SVD severity and presentations, age and risk factors for SVD. Results: Amongst 123 relevant studies (n = 36,910 participants) including 53 community-based, 67 hospital-based and three mixed studies published between 1989 and 2020, more males were recruited in hospital-based than in community-based studies [M:F = 1.16 (0.70) vs. M:F = 0.79 (0.35), respectively; p < 0.001]. More males had moderate to severe SVD [M:F = 1.08 (0.81) vs. M:F = 0.82 (0.47) in healthy to mild SVD; p < 0.001], and stroke presentations where M:F was 1.67 (0.53). M:F did not differ for recent (2015-2020) vs. pre-2015 publications, by geographical region, or age. There were insufficient sex-stratified data to explore M:F and risk factors for SVD. Conclusions: Our results highlight differences in male-to-female ratios in SVD severity and amongst those presenting with stroke that have important clinical and translational implications. Future SVD research should report participant demographics, risk factors and outcomes separately for males and females. Systematic Review Registration: [PROSPERO], identifier [CRD42020193995].
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Affiliation(s)
- Lorena Jiménez-Sánchez
- Translational Neuroscience PhD Programme, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Olivia K. L. Hamilton
- Translational Neuroscience PhD Programme, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Edinburgh Dementia Research Centre in the UK Dementia Research Institute, Edinburgh, United Kingdom
| | - Una Clancy
- Edinburgh Dementia Research Centre in the UK Dementia Research Institute, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Ellen V. Backhouse
- Edinburgh Dementia Research Centre in the UK Dementia Research Institute, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Catriona R. Stewart
- Edinburgh Dementia Research Centre in the UK Dementia Research Institute, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Michael S. Stringer
- Edinburgh Dementia Research Centre in the UK Dementia Research Institute, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Fergus N. Doubal
- Edinburgh Dementia Research Centre in the UK Dementia Research Institute, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Edinburgh Dementia Research Centre in the UK Dementia Research Institute, Edinburgh, United Kingdom
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, United Kingdom
- Lothian Birth Cohorts, University of Edinburgh, Edinburgh, United Kingdom
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Akhter F, Persaud A, Zaokari Y, Zhao Z, Zhu D. Vascular Dementia and Underlying Sex Differences. Front Aging Neurosci 2021; 13:720715. [PMID: 34566624 PMCID: PMC8457333 DOI: 10.3389/fnagi.2021.720715] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
Vascular dementia (VaD) is the second most common form of dementia after Alzheimer's disease (AD); where Alzheimer's accounts for 60-70% of cases of dementia and VaD accounts for 20% of all dementia cases. VaD is defined as a reduced or lack of blood flow to the brain that causes dementia. VaD is also known occasionally as vascular contributions to cognitive impairment and dementia (VCID) or multi-infarct dementia (MID). VCID is the condition arising from stroke and other vascular brain injuries that cause significant changes to memory, thinking, and behavior, and VaD is the most severe stage while MID is produced by the synergistic effects caused by multiple mini strokes in the brain irrespective of specific location or volume. There are also subtle differences in the presentation of VaD in males and females, but they are often overlooked. Since 1672 when the first case of VaD was reported until now, sex and gender differences have had little to no research done when it comes to the umbrella term of dementia in general. This review summarizes the fundamentals of VaD followed by a focus on the differences between sex and gender when an individual is diagnosed. In addition, we provide critical evidence concerning sex and gender differences with a few of the main risk factors of VaD including pre-existing health conditions and family history, gene variants, aging, hormone fluctuations, and environmental risk factors. Additionally, the pharmaceutical treatments and possible mitigation of risk factors is explored.
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Affiliation(s)
- Firoz Akhter
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, United States
| | - Alicia Persaud
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, United States
| | - Younis Zaokari
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, United States
| | - Zhen Zhao
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Donghui Zhu
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, United States
- Neuroscience Graduate Program, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
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11
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Hsu CL, Iwanowski P, Hsu CH, Kozubski W. Genetic diseases mimicking multiple sclerosis. Postgrad Med 2021; 133:728-749. [PMID: 34152933 DOI: 10.1080/00325481.2021.1945898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple sclerosis (MS) is an inflammatory neurodegenerative disorder manifesting as gradual or progressive loss of neurological functions. Most patients present with relapsing-remitting disease courses. Extensive research over recent decades has expounded our insights into the presentations and diagnostic features of MS. Groups of genetic diseases, CADASIL and leukodystrophies, for example, have been frequently misdiagnosed with MS due to some overlapping clinical and radiological features. The delayed identification of these diseases in late adulthood can lead to severe neurological complications. Herein we discuss genetic diseases that have the potential to mimic multiple sclerosis, with highlights on clinical identification and practicing pearls that may aid physicians in recognizing MS-mimics with genetic background in clinical settings.
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Affiliation(s)
- Chueh Lin Hsu
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Iwanowski
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Chueh Hsuan Hsu
- Department of Neurology, China Medical University, Taichung, Taiwan
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
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12
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Migraine and rare neurological disorders. Neurol Sci 2020; 41:439-446. [DOI: 10.1007/s10072-020-04645-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Xiromerisiou G, Marogianni C, Dadouli K, Zompola C, Georgouli D, Provatas A, Theodorou A, Zervas P, Nikolaidou C, Stergiou S, Ntellas P, Sokratous M, Stathis P, Paraskevas GP, Bonakis A, Voumvourakis K, Hadjichristodoulou C, Hadjigeorgiou GM, Tsivgoulis G. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy revisited: Genotype-phenotype correlations of all published cases. NEUROLOGY-GENETICS 2020; 6:e434. [PMID: 32582863 PMCID: PMC7238894 DOI: 10.1212/nxg.0000000000000434] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/02/2020] [Indexed: 01/18/2023]
Abstract
Objective The aim of this study was to evaluate the correlation between the various NOTCH3 mutations and their clinical and genetic profile, along with the presentation of a novel mutation in a patient. Methods Here, we describe the phenotype of a patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) harboring a novel mutation. We also performed an extensive literature research for NOTCH3 mutations published since the identification of the gene and performed a systematic review of all published cases with NOTCH3 mutations. We evaluated the mutation pathogenicity in a great number of patients with detailed clinical and genetic evaluation and investigated the possible phenotype-genotype correlations. Results Our patient harbored a novel mutation in the NOTCH3 gene, the c.3084 G > C, corresponding to the aminoacidic substitution p.Trp1028Cys, presenting with seizures as the first neurologic manifestation. We managed to find a correlation between the pathogenicity of mutations, severity of the phenotype, and age at onset of CADASIL. Significant differences were also identified between men and women regarding the phenotype severity. Conclusions The collection and analysis of these scarce data published since the identification of NOTCH3 qualitatively by means of a systematic review and quantitatively regarding genetic profile and pathogenicity scores, highlight the significance of the ongoing trend of investigating phenotypic genotypic correlations.
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Affiliation(s)
- Georgia Xiromerisiou
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Chrysoula Marogianni
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Katerina Dadouli
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Christina Zompola
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Despoina Georgouli
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Antonios Provatas
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Aikaterini Theodorou
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Paschalis Zervas
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Christina Nikolaidou
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Stergios Stergiou
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Panagiotis Ntellas
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Maria Sokratous
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Pantelis Stathis
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Georgios P Paraskevas
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Anastasios Bonakis
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Konstantinos Voumvourakis
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Christos Hadjichristodoulou
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Georgios M Hadjigeorgiou
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
| | - Georgios Tsivgoulis
- Department of Neurology (G.X., C.M., D.G., A.P., M.S., G.M.H.), University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece; Second Department of Neurology (C.Z., A.T., P.Z., A.B., K.V., G.T.), "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece; Department of Neurology (G.M.H.), Medical School, University of Cyprus, Nicosia, Cyprus; Department of Hygiene and Epidemiology (K.D., C.H.), Faculty of Medicine, University of Thessaly, Larissa, Greece; Department of Medical Oncology (P.N.), University Hospital of Ioannina, Ioannina, Greece; Department of Neurology (P.S.), Mediterraneo Hospital, Glyfada, Athens, Greece; Histopathological Department (C.N., S.S.), Hippokration General Hospital Thessaloniki; and Department of Neurology (G.P.P.), School of Medicine, National and Kapodistrian University of Athens, Eginition Hospital, Athens, Greece
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Reduced resting-state brain functional network connectivity and poor regional homogeneity in patients with CADASIL. J Headache Pain 2019; 20:103. [PMID: 31711415 PMCID: PMC6849263 DOI: 10.1186/s10194-019-1052-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/10/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) manifests principally as a suite of cognitive impairments, particularly in the executive domain. Executive functioning requires the dynamic coordination of neural activity over large-scale networks. It remains unclear whether changes in resting-state brain functional network connectivity and regional homogeneities (ReHos) underly the mechanisms of executive dysfunction evident in CADASIL patients. METHODS In this study, 22 CADASIL patients and 44 matched healthy controls underwent resting-state functional magnetic resonance imaging (fMRI). Independent component analysis (ICA) was used to measure functional brain network connectivity, and ReHos were calculated to evaluate local brain activities. We used seed-based functional connectivity (FC) analyses to determine whether dysfunctional areas (as defined by ReHos) exhibited abnormal FC with other brain areas. Relationships among the mean intra-network connectivity z-scores of dysfunctional areas within functional networks, and cognitive scores were evaluated using Pearson correlation analyses. RESULTS Compared to the controls, CADASIL patients exhibited decreased intra-network connectivity within the bilateral lingual gyrus (LG) and the right cuneus (CU) (thus within the visual network [VIN)], and within the right precuneus (Pcu), inferior frontal gyrus (IFG), and precentral gyrus (thus within the frontal network [FRN]). Compared to the controls, patients also exhibited significantly lower ReHos in the right precuneus and cuneus (Pcu/CU), visual association cortex, calcarine gyri, posterior cingulate, limbic lobe, and weaker FC between the right Pcu/CU and the bilateral parahippocampal gyrus (PHG), and between the right Pcu/CU and the right postcentral gyrus. Notably, the mean connectivity z-scores of the bilateral LG and the right CU within the VIN were positively associated with compromised attention, calculation and delayed recall as revealed by tests of the various cognitive domains explored by the Mini-Mental State Examination. CONCLUSIONS The decreases in intra-network connectivity within the VIN and FRN and reduced local brain activity in the posterior parietal area suggest that patients with CADASIL may exhibit dysfunctional visuomotor behaviors (a hallmark of executive function), and that all visual information processing, visuomotor planning, and movement execution may be affected.
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Altered Brain Glucose Metabolism Assessed by 18F-FDG PET Imaging Is Associated with the Cognitive Impairment of CADASIL. Neuroscience 2019; 417:35-44. [PMID: 31394195 DOI: 10.1016/j.neuroscience.2019.07.048] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 12/26/2022]
Abstract
Recurrent stroke and cognitive impairment are the primary features of patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The cognitive deficits in these patients are known to be correlated with structural brain changes, such as white matter lesions and lacunae, and resting-state functional connectivity in brain networks. However, the associations between changes in brain glucose metabolism based on 18F-2-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET) imaging and cognitive scores in CADASIL patients remain unclear. In the present study, 24 CADASIL patients and 24 matched healthy controls underwent 18F-FDG PET imaging. Brain glucose metabolism was measured in all subjects and Pearson's correlation analyses were performed to evaluate relationships between abnormal glucose metabolism in various brain areas and cognitive scores. Compared to controls, CADASIL patients exhibited significantly lower metabolism in the right cerebellar posterior lobe, left cerebellar anterior lobe, bilateral thalamus and left limbic lobe. Additionally, hypermetabolism was observed in the left precentral and postcentral gyri. Importantly, glucose metabolism in the left limbic lobe was positively associated with cognitive scores on the Mini-Mental State Examination (MMSE). Furthermore, glucose metabolism in the left precentral gyri was negatively correlated with cognitive scores on the Montreal Cognitive Assessment (MoCA). The present findings provide strong support for the presence of altered brain glucose metabolism in CADASIL patients as well as the associations between abnormal metabolism and cognitive scales in this population. The present findings suggest that patterns of brain glucose metabolism may become useful markers of cognitive impairment in CADASIL patients.
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16
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Osman O, De Guio F, Chabriat H, Jouvent E. Why Are Only Some Subcortical Ischemic Lesions on Diffusion Magnetic Resonance Imaging Associated With Stroke Symptoms in Small Vessel Disease? Stroke 2018; 49:1920-1923. [PMID: 29986933 DOI: 10.1161/strokeaha.118.021342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- In cerebral small vessel diseases, small subcortical ischemic lesions (SSIL) on diffusion imaging are responsible for stroke manifestations but can also be occasionally observed in the absence of overt neurological symptoms. We aimed to determine, in a large cohort of young patients with CADASIL (Cerebral Autosomal-Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy), a severe monogenic condition leading to SSIL in young patients, the characteristics of SSIL and of surrounding cerebral tissue associated with the presence of stroke symptoms. Methods- Among a cohort of 323 genetically confirmed CADASIL patients who were systematically evaluated every 18 months clinically and with magnetic resonance imaging, we studied all visible SSIL and documented ischemic stroke events with available magnetic resonance imaging data. We used mixed-effect logistic regression models to determine whether the presence of stroke symptoms was associated with age, sex, the volume of SSIL, their location with respect to preexisting white matter hyperintensities and with the load of the different magnetic resonance imaging markers of small vessel disease. Results- We identified 73 SSIL (30 with stroke symptoms and 43 without) in 55 patients. In multivariable models, stroke symptoms were more frequent in male patients (estimate=1.94; SE=0.82; P=0.03) and less frequent when SSIL appeared in contact to preexisting white matter hyperintensities (estimate=-2.12; SE=0.83; P=0.01). Within pyramidal tracts, stroke symptoms were more frequent in patients with extensive white matter hyperintensities (estimate=3.8×10-5; SE=9.3×10-6; P<10-4). Conclusions- Altogether, our results suggest that when SSIL occur, the presence of stroke symptoms may depend on sex and alterations of the surrounding brain tissue rather than on the characteristics of the SSIL itself.
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Affiliation(s)
- Ophélie Osman
- From the Department of Neurology, APHP, Lariboisière Hospital, Paris, France (O.O., H.C., E.J.).,University Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, France (O.O., F.D.G., H.C., E.J.)
| | - François De Guio
- University Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, France (O.O., F.D.G., H.C., E.J.).,DHU NeuroVasc Sorbonne Paris Cité, France (F.D.G., H.C., E.J.)
| | - Hugues Chabriat
- From the Department of Neurology, APHP, Lariboisière Hospital, Paris, France (O.O., H.C., E.J.).,University Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, France (O.O., F.D.G., H.C., E.J.).,DHU NeuroVasc Sorbonne Paris Cité, France (F.D.G., H.C., E.J.)
| | - Eric Jouvent
- From the Department of Neurology, APHP, Lariboisière Hospital, Paris, France (O.O., H.C., E.J.).,University Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, France (O.O., F.D.G., H.C., E.J.).,DHU NeuroVasc Sorbonne Paris Cité, France (F.D.G., H.C., E.J.)
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17
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Tsai HH, Kim JS, Jouvent E, Gurol ME. Updates on Prevention of Hemorrhagic and Lacunar Strokes. J Stroke 2018; 20:167-179. [PMID: 29886717 PMCID: PMC6007298 DOI: 10.5853/jos.2018.00787] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/16/2018] [Accepted: 05/23/2018] [Indexed: 12/22/2022] Open
Abstract
Intracerebral hemorrhage (ICH) and lacunar infarction (LI) are the major acute clinical manifestations of cerebral small vessel diseases (cSVDs). Hypertensive small vessel disease, cerebral amyloid angiopathy, and hereditary causes, such as Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), constitute the three common cSVD categories. Diagnosing the underlying vascular pathology in these patients is important because the risk and types of recurrent strokes show significant differences. Recent advances in our understanding of the cSVD-related radiological markers have improved our ability to stratify ICH risk in individual patients, which helps guide antithrombotic decisions. There are general good-practice measures for stroke prevention in patients with cSVD, such as optimal blood pressure and glycemic control, while individualized measures tailored for particular patients are often needed. Antithrombotic combinations and anticoagulants should be avoided in cSVD treatment, as they increase the risk of potentially fatal ICH without necessarily lowering LI risk in these patients. Even when indicated for a concurrent pathology, such as nonvalvular atrial fibrillation, nonpharmacological approaches should be considered in the presence of cSVD. More data are emerging regarding the presentation, clinical course, and diagnostic markers of hereditary cSVD, allowing accurate diagnosis, and therefore, guiding management of symptomatic patients. When suspicion for asymptomatic hereditary cSVD exists, the pros and cons of prescribing genetic testing should be discussed in detail in the absence of any curative treatment. Recent data regarding diagnosis, risk stratification, and specific preventive approaches for both sporadic and hereditary cSVDs are discussed in this review article.
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Affiliation(s)
- Hsin-Hsi Tsai
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Neurology, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eric Jouvent
- Department of Neurology, University Paris Diderot, Paris, France
| | - M Edip Gurol
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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18
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Iqbal F, Durham WJ, Melhem A, Raslan S, Tran TT, Wright TJ, Asghar R, Fujise K, Volpi E, Sidossis L, Abate N, Sheffield-Moore M, Tuvdendorj D. Sex-dependent difference in the relationship between adipose-tissue cholesterol efflux and estradiol concentrations in young healthy humans. Int J Dev Neurosci 2017; 64:59-62. [PMID: 28709820 DOI: 10.1016/j.ijdevneu.2017.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/16/2017] [Accepted: 07/09/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Impaired adipose tissue function and lower levels of high density lipoprotein cholesterol (HDL-C) have been implicated in the development of vascular dementia, and metabolic diseases such as hypertension, atherosclerosis, type 2 diabetes (T2D) and metabolic syndrome. Interestingly, both the substrate fluxes in adipose tissue and HDL-C concentration differ between men and women. Moreover, adipose tissue cholesterol efflux has been implicated in modulation of HDL-C levels. Thus, we aimed to determine if the association between serum estradiol levels and adipose tissue cholesterol efflux is sex-dependent. METHOD We evaluated the serum estradiol levels and adipose tissue cholesterol efflux in young healthy men (n=5) and women (n=3). Adipose tissue cholesterol efflux was determined using subcutaneous microdialysis probes. Linear regression analyses were used to determine the relationship between the parameters, p<0.05 was considered as statistically significant. RESULTS Our data demonstrated that serum estradiol levels directly associated with adipose tissue cholesterol efflux; however, the relationships may be sex-dependent. We discussed our results in the context of currently available data regarding sex-dependent variability in adipose tissue function and HDL-C metabolism as a potential contributor to higher rates of vascular dementia in men. Further research is required to understand the sex-dependent and -independent variabilities in adipose tissue metabolism to determine novel targets for interventions to prevent the development of vascular dementia.
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Affiliation(s)
- Fatima Iqbal
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - William J Durham
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Ayyash Melhem
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Saleem Raslan
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Tony T Tran
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Traver J Wright
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Rabia Asghar
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Ken Fujise
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Elena Volpi
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Labros Sidossis
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Nicola Abate
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Melinda Sheffield-Moore
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States
| | - Demidmaa Tuvdendorj
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77555, United States.
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Moroz AA, Abramycheva NY, Stepanova MS, Konovalov RN, Timerbaeva SL, Illarioshkin SN. [Differential diagnosis of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:75-80. [PMID: 28617385 DOI: 10.17116/jnevro20171174175-80] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarctions and leucoencephalopathy (CADASIL) is an inherited CNS disease, which is caused by mutations in the NOTCH3 gene. Selective disorders of small vessels underlie the disease pathogenesis. Clinically CADASIL is characterized by headaches, multiple stroke-like disorders (in most cases transient ischemic attacks and lacunar strokes), and different focal neurological symptoms and dementia. There are specific MRI signs of the disease: multiple lacunar infarctions located in the basal ganglia, brain steam and cerebellum, focal lesions of temporal poles, capsula externa, periventricular and subcortical areas; diffuse white matter changes and leukoaraiosis can be observed as well. The differential diagnosis of CADASIL is made with many diseases, which are manifested by multiple brain matter lesions, including demyelinating disorders. It should be taken into account that CADASIL is characterized by headaches as one of the initial symptoms, multiple lacunar and diffuse brain matter lesions based on MRI data with an absence of atherosclerosis and arterial hypertension. Family history and autosomal dominant mode of inheritance is also typical of CADASIL. Detection of the NOTCH3 gene mutation is necessary for the definite diagnosis of CADASIL.
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Affiliation(s)
- A A Moroz
- Research Сenter of Neurology, Moscow, Russia
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21
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Di Donato I, Bianchi S, De Stefano N, Dichgans M, Dotti MT, Duering M, Jouvent E, Korczyn AD, Lesnik-Oberstein SAJ, Malandrini A, Markus HS, Pantoni L, Penco S, Rufa A, Sinanović O, Stojanov D, Federico A. Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) as a model of small vessel disease: update on clinical, diagnostic, and management aspects. BMC Med 2017; 15:41. [PMID: 28231783 PMCID: PMC5324276 DOI: 10.1186/s12916-017-0778-8] [Citation(s) in RCA: 134] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/03/2017] [Indexed: 12/11/2022] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common and best known monogenic small vessel disease. Here, we review the clinical, neuroimaging, neuropathological, genetic, and therapeutic aspects based on the most relevant articles published between 1994 and 2016 and on the personal experience of the authors, all directly involved in CADASIL research and care. We conclude with some suggestions that may help in the clinical practice and management of these patients.
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Affiliation(s)
- Ilaria Di Donato
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Silvia Bianchi
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Maria Teresa Dotti
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Marco Duering
- Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University LMU, Munich, Germany
| | - Eric Jouvent
- Université Paris Diderot, Sorbonne Paris Cité, UMR-S 1161 INSERM, F-75205, Paris, France.,Department of Neurology, AP-HP, Lariboisière Hospital, F-75475, Paris, France.,DHU NeuroVasc Sorbonne Paris Cité, Paris, France
| | - Amos D Korczyn
- Department of Neurology, Tel Aviv University, Ramat Aviv, 69978, Israel
| | - Saskia A J Lesnik-Oberstein
- Department of Clinical Genetics, K5-R Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Alessandro Malandrini
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Hugh S Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, UK
| | - Leonardo Pantoni
- NEUROFARBA Department, Neuroscience section, Largo Brambilla 3, 50134, Florence, Italy
| | - Silvana Penco
- Medical Genetic Unit, Department of Laboratory Medicine, Niguarda Hospital, Milan, Italy
| | - Alessandra Rufa
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy
| | - Osman Sinanović
- Department of Neurology, University Clinical Center Tuzla, School of Medicine University of Tuzla, 75000, Tuzla, Bosnia and Herzegovina
| | - Dragan Stojanov
- Faculty of Medicine, University of Nis, Bul. Dr. Zorana Djindjica 81, Nis, 18000, Serbia
| | - Antonio Federico
- Department of Medicine, Surgery and Neurosciences, Medical School, University of Siena, Viale Bracci 2, 53100, Siena, Italy.
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Guey S, Mawet J, Hervé D, Duering M, Godin O, Jouvent E, Opherk C, Alili N, Dichgans M, Chabriat H. Prevalence and characteristics of migraine in CADASIL. Cephalalgia 2016; 36:1038-1047. [PMID: 26646784 DOI: 10.1177/0333102415620909] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background and objective Migraine with aura (MA) is a major symptom of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). We assessed the spectrum of migraine symptoms and their potential correlates in a large prospective cohort of CADASIL individuals. Methods A standardized questionnaire was used in 378 CADASIL patients for assessing headache symptoms, trigger factors, age at first attack, frequency of attacks and associated symptoms. MRI lesions and brain atrophy were quantified. Results A total of 54.5% of individuals had a history of migraine, mostly MA in 84% of them; 62.4% of individuals with MA were women and age at onset of MA was lower in women than in men. Atypical aura symptoms were experienced by 59.3% of individuals with MA, and for 19.7% of patients with MA the aura was never accompanied by headache. MA was the inaugural manifestation in 41% of symptomatic patients and an isolated symptom in 12.1% of individuals. Slightly higher MMSE and MDRS scores and lower Rankin score were detected in the MA group. Conclusion MA is observed in almost half of all CADASIL patients. Atypical aura symptoms are reported by more than one in two of them. MA is often inaugural, can remain isolated and is not associated with the severity of the disorder.
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Affiliation(s)
- Stephanie Guey
- 1 Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, France.,2 INSERM, UMR 1161, France
| | - Jérôme Mawet
- 1 Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, France.,3 Emergency Headache Center, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, France
| | - Dominique Hervé
- 1 Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, France.,2 INSERM, UMR 1161, France
| | - Marco Duering
- 4 Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Germany
| | - Ophelia Godin
- 1 Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, France
| | - Eric Jouvent
- 1 Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, France.,2 INSERM, UMR 1161, France
| | | | - Nassira Alili
- 1 Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, France
| | - Martin Dichgans
- 4 Institute for Stroke and Dementia Research, Klinikum der Universität München, Ludwig-Maximilians-University, Germany.,6 Munich Cluster for Systems Neurology (SyNergy), Germany
| | - Hugues Chabriat
- 1 Department of Neurology, GH Saint-Louis-Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Denis Diderot and DHU NeuroVasc Sorbonne Paris-Cité, France.,2 INSERM, UMR 1161, France
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Tan RYY, Markus HS. CADASIL: Migraine, Encephalopathy, Stroke and Their Inter-Relationships. PLoS One 2016; 11:e0157613. [PMID: 27309730 PMCID: PMC4911105 DOI: 10.1371/journal.pone.0157613] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/01/2016] [Indexed: 01/03/2023] Open
Abstract
Background Migraine is common in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) but its treatment responses are not well described, and its relationship to stroke risk unknown. Encephalopathy is a less common presentation; it has been suggested it is related to migraine. We characterised migraine patterns and treatment responses in CADASIL, and examined associations between migraine and both stroke risk and encephalopathy. Methods 300 symptomatic CADASIL patients were prospectively recruited from a national referral clinic over a nineteen year period, from 1996 to 2015. Data was collected using a standardised questionnaire. Migraine was classified according to the International Classification of Headache Disorders, 3rd edition (beta version). A cross-sectional analysis was carried out on the data collected. Results Migraine was present in 226 (75.3%), and the presenting feature in 203 (67.7%). It was usually accompanied by aura (89.8%). Patients showed variable responses to a variety of drugs for migraine. Of 24 given triptans, 45.5% had consistent or partial responses. None had complications following triptans. Thirty-three (11.0%) patients experienced encephalopathy lasting on average 8.1 ± 3.4 days. Patients with migraine with aura had higher odds of encephalopathy (OR = 5.4; 95%CI 1.6–28.4; p = 0.002). Patients with confusional aura had higher odds of encephalopathy than those with other aura types (OR = 2.5, 95%CI = 1.0–5.8, p = 0.04). There was also no increase in risk of encephalopathy with sex or age at onset of migraine. Migraineurs had a lower stroke risk than non-migraineurs (HR = 0.46, 95%CI 0.3–0.6, p = 2.1x10-6). Conclusions Migraine with aura is a prominent feature of CADASIL. Treatment responses are similar to those seen in the general migraine population and no complications were observed with triptans. Migraine with aura was associated with increased risk of encephalopathy suggesting they may share pathophysiological mechanisms. There was no increased stroke risk associated with migraine, but risk appeared to be reduced although this finding needs confirming.
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Affiliation(s)
- Rhea Yan Ying Tan
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
- * E-mail:
| | - Hugh Stephen Markus
- Stroke Research Group, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom
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CADASIL presenting as schizophreniform organic psychosis. Gen Hosp Psychiatry 2015; 37:273.e11-3. [PMID: 25824603 DOI: 10.1016/j.genhosppsych.2015.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe an Asian patient with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) presenting with schizophreniform organic psychosis. METHODS Case report. RESULTS We report a case of CADASIL in an Asian female presenting with frank psychotic symptoms. After resolution of her psychosis, she showed persistent distractibility, which indicated signs of cognitive impairment. CONCLUSION Although neuropsychiatric symptoms are commonly present in this disorder, psychotic symptoms are rare and should be recognized. There is a need for timely diagnosis and management of this disorder.
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Guidetti D, Rota E, Morelli N, Immovilli P. Migraine and stroke: "vascular" comorbidity. Front Neurol 2014; 5:193. [PMID: 25339937 PMCID: PMC4189436 DOI: 10.3389/fneur.2014.00193] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 09/15/2014] [Indexed: 01/03/2023] Open
Abstract
Several comorbidities are associated to migraine. Recent meta-analyses have consistently demonstrated a relationship between migraine and stroke, which is well-defined for ischemic stroke and migraine with aura (MA), even stronger in females on oral contraceptives or smokers. However, there seems to be no clear-cut association between stroke in migraineurs and the common vascular risk factors, at least in the young adult population. Migraineurs also run an increased risk of hemorrhagic stroke, while the association between migraine and cardiovascular disease remains poorly defined. Another aspect is the relationship between migraine and the presence of silent brain lesions. It has been demonstrated that there is an increased frequency of ischemic lesions in the white matter of migraineurs, especially silent infarcts in the posterior circulation territory in patients with at least 10 attacks per month. Although there is a higher prevalence of patent foramen ovale (PFO) in migraineurs, the relationship between migraine and PFO remains controversial and PFO closure is not a recommended procedure to prevent migraine. As an increased frequency of cervical artery dissections has been observed in migrainous patients, it has been hypothesized that migraine may represent a predisposing factor for cervical artery dissection. There still remains the question as to whether migraine should be considered a true “vascular disease” or if the comorbidity between migraine and cerebrovascular disease may have underlying shared risk factors or pathophysiological mechanisms. Although further studies are required to clarify this issue, current evidence supports a clinical management where MA patients should be screened for other concomitant vascular risk factors and treated accordingly.
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Affiliation(s)
- Donata Guidetti
- Neurology Unit, Guglielmo da Saliceto Hospital , Piacenza , Italy
| | - Eugenia Rota
- Neurology Unit, Guglielmo da Saliceto Hospital , Piacenza , Italy
| | - Nicola Morelli
- Neurology Unit, Guglielmo da Saliceto Hospital , Piacenza , Italy
| | - Paolo Immovilli
- Neurology Unit, Guglielmo da Saliceto Hospital , Piacenza , Italy
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Moccia M, Mosca L, Erro R, Cervasio M, Allocca R, Vitale C, Leonardi A, Caranci F, Del Basso-De Caro ML, Barone P, Penco S. Hypomorphic NOTCH3 mutation in an Italian family with CADASIL features. Neurobiol Aging 2014; 36:547.e5-11. [PMID: 25260852 DOI: 10.1016/j.neurobiolaging.2014.08.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 07/31/2014] [Accepted: 08/22/2014] [Indexed: 11/17/2022]
Abstract
The cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL) is because of NOTCH3 mutations affecting the number of cysteine residues. In this view, the role of atypical NOTCH3 mutations is still debated. Therefore, we investigated a family carrying a NOTCH3 nonsense mutation, with dominantly inherited recurrent cerebrovascular disorders. Among 7 family members, 4 received a clinical diagnosis of CADASIL. A heterozygous truncating mutation in exon 3 (c.307C>T, p.Arg103X) was found in the 4 clinically affected subjects and in one 27-year old lady, only complaining of migraine with aura. Magnetic resonance imaging scans found typical signs of small-vessel disease in the 4 affected subjects, supporting the clinical diagnosis. Skin biopsies did not show the typical granular osmiophilic material, but only nonspecific signs of vascular damage, resembling those previously described in Notch3 knockout mice. Interestingly, messenger RNA (mRNA) analysis supports the hypothesis of an atypical NOTCH3 mutation, suggesting a nonsense-mediated mRNA decay. In conclusion, the present study broadens the spectrum of CADASIL mutations, and, therefore, opens new insights about Notch3 signaling.
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Affiliation(s)
- Marcello Moccia
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Lorena Mosca
- Medical Genetics Unit, Department of Laboratory Medicine, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Roberto Erro
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, Queen Square, London, UK
| | - Mariarosaria Cervasio
- Department of Advanced Biomedical Sciences, Anatomopathology Unit, Federico II University, Naples, Italy
| | - Roberto Allocca
- Department of Neuroscience, Reproductive Science and Odontostomatology, Federico II University, Naples, Italy
| | - Carmine Vitale
- Department of Motor Sciences, University of Naples "Parthenope," Naples, Italy; Istituto di Diagnosi e Cura (IDC) Hermitage-Capodimonte, Naples, Italy
| | - Antonio Leonardi
- Department of Molecular and Biotechnological Medicine, Federico II University, Naples, Italy
| | - Ferdinando Caranci
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, Federico II University, Naples, Italy
| | | | - Paolo Barone
- Center for Neurodegenerative Diseases (CEMAND), Neuroscience Section, Department of Medicine, University of Salerno, Salerno, Italy
| | - Silvana Penco
- Medical Genetics Unit, Department of Laboratory Medicine, Niguarda Ca'Granda Hospital, Milan, Italy.
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Ince B, Benbir G, Siva A, Saip S, Utku U, Celik Y, Necioglu-Orken D, Ozturk S, Afsar N, Aktan S, Asil T, Bakac G, Ekmekci H, Gokce M, Krespi Y, Midi I, Varlibas F, Citci-Yalcinkaya B, Goksan B, Uluduz D, Uyguner O. Clinical and radiological features in CADASIL and NOTCH3-negative patients: a multicenter study from Turkey. Eur Neurol 2014; 72:125-31. [PMID: 25095812 DOI: 10.1159/000360530] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 02/09/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The diversity of clinical presentation and neuroimaging findings of CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) from different regions of the world has not yet been studied in depth. Here we investigated the variability of clinical, radiological and genetic data of 48 patients analyzed for NOTCH3 mutation in Turkey. METHODS Clinical evaluation was made according to a preformed questionnaire. Cranial neuroimaging findings were determined on the basis of T1, T2, FLAIR and proton-density magnetic resonance scans. For genetic analysis, polymerase chain reaction was performed with primers flanking exons 2-6 and 11 of NOTCH3 gene. RESULTS Twenty-five patients (52.1%) were diagnosed as CADASIL with NOTCH3 mutation, while 23 patients (47.9%) had no mutation (NOTCH3-negative patients). The mean age and age at stroke onset were lower in male CADASIL patients (p < 0.03). A family history of migraine (p = 0.012), stroke (p < 0.001), recurrent strokes (p = 0.020) and dementia (p = 0.012) was more common in CADASIL patients. Temporal pole involvement was more common in CADASIL patients (p = 0.004). CONCLUSION It is of clinical importance to identify the heterogeneity of CADASIL from different countries due to a low correlation of clinical and radiological data with respect to NOTCH3 mutation.
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Affiliation(s)
- Birsen Ince
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Glover RL, Vollbracht S, Robbins MS. Acute Postpartum Headache. Headache 2014; 54:1073-84. [DOI: 10.1111/head.12385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2014] [Indexed: 01/18/2023]
Affiliation(s)
- Robert L. Glover
- Department of Neurology; Albert Einstein College of Medicine; Bronx NY USA
| | - Sarah Vollbracht
- Department of Neurology; Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Headache Center; Albert Einstein College of Medicine; Bronx NY USA
| | - Matthew S. Robbins
- Department of Neurology; Albert Einstein College of Medicine; Bronx NY USA
- Montefiore Headache Center; Albert Einstein College of Medicine; Bronx NY USA
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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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Ragno M, Trojano L. Management of CADASIL syndrome. Expert Opin Orphan Drugs 2013. [DOI: 10.1517/21678707.2013.828998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Michele Ragno
- Division of Neurology, Ospedale Madonna del Soccorso, San Benedetto del Tronto (AP), Italy
| | - Luigi Trojano
- Second University of Naples, Department of Psychology, Caserta, Italy ;
- Rehabilitation Institute of Telese Terme, Salvatore Maugeri Foundation, IRCCS, Telese Terme (BN), Italy
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Righart R, Duering M, Gonik M, Jouvent E, Reyes S, Hervé D, Chabriat H, Dichgans M. Impact of regional cortical and subcortical changes on processing speed in cerebral small vessel disease. NEUROIMAGE-CLINICAL 2013; 2:854-61. [PMID: 24179837 PMCID: PMC3777834 DOI: 10.1016/j.nicl.2013.06.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 05/20/2013] [Accepted: 06/12/2013] [Indexed: 11/06/2022]
Abstract
Slowed processing speed is common in elderly subjects and frequently related to cerebral small vessel disease. Previous studies have demonstrated associations between processing speed and subcortical ischemic lesions as well as cortical alterations but the precise functional–anatomical relationships remain poorly understood. Here we assessed the impact of both cortical and subcortical changes on processing speed by measuring regional cortical thickness and regional lesion volumes within distinct white-matter tracts. To limit confounding effects from age-related pathologies we studied patients with CADASIL, a genetic small vessel disease. General linear model analysis revealed significant associations between cortical thickness in the medial frontal and occipito-temporal cortex and processing speed. Bayesian network analysis showed a robust conditional dependency between the volume of lacunar lesions in the left anterior thalamic radiation and cortical thickness of the left medial frontal cortex, and between thickness of the left medial frontal cortex and processing speed, whereas there was no direct dependency between lesion volumes in the left anterior thalamic radiation and processing speed. Our results suggest that the medial frontal cortex has an intermediate position between lacunar lesions in the anterior thalamic radiation and deficits in processing speed. In contrast, we did not observe such a relationship for the occipito-temporal region. These findings reinforce the key role of frontal–subcortical circuits in cognitive impairment resulting from cerebral small vessel disease. Slowed processing speed is a key feature of cerebral small vessel disease. Processing speed correlates with cortical thickness in frontal and occipital areas. Effects of ischemic lesions on processing speed are mediated by cortical changes.
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Affiliation(s)
- Ruthger Righart
- Institute for Stroke and Dementia Research, Ludwig-Maximilians-University, 81377 Munich, Germany ; German Center for Neurodegenerative Diseases (DZNE, Munich), 80336 Munich, Germany
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Unusual Clinical Presentations in Subjects Carrying Novel NOTCH3 Gene Mutations. J Stroke Cerebrovasc Dis 2013; 22:539-44. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 01/14/2013] [Accepted: 02/01/2013] [Indexed: 11/21/2022] Open
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Vyshka G, Kruja J. Clinical variability of the cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy phenotype in two siblings of a large family showing the same mutation. Int Med Case Rep J 2013; 6:59-63. [PMID: 24124395 PMCID: PMC3794843 DOI: 10.2147/imcrj.s51875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A 44-year-old Albanian male was consulted and diagnosed with dementia. His magnetic resonance imaging suggested diffuse white matter changes. The suspicion of cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) was raised, and a genetic analysis confirmed such a suspicion through uncovering a pathogenic mutation at the level of exon 4 (c.475C>T) of chromosome 19. The patient came from a large family of 13 children, all of whom underwent clinical, genetic, and imaging examination. The pathogenic mutation was found present only in his eldest sister (50 years old), and she presented also very suggestive signs of CADASIL in her respective imaging study, but without any clinically significant counterpart. All other siblings were free from clinical and radiological signs of the disorder. Our opinion was that we were dealing with a mutation showing a very low level of penetrance, with only two siblings affected in a large Albanian family with 13 children.
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Affiliation(s)
- Gentian Vyshka
- Biomedical and Experimental Department, University of Medicine Tirana, Albania
- Correspondence: Gentian Vyshka, Biomedical and Experimental Department, Faculty of Medicine, University of Medicine Tirana, 371 Rruga Dibres, Tirana 1005, Albania, Tel +355 69 282 8140, Email
| | - Jera Kruja
- Neurology Department, Mother Theresa University Hospital Centre, Tirana, Albania
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Muqtadar H, Testai FD. Single Gene Disorders Associated With Stroke: A Review and Update on Treatment Options. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:288-97. [DOI: 10.1007/s11936-012-0179-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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