CADASIL (Cerebral Autosomal Dominant Arteriopathy with Sub-cortical Infarcts and Leukoencephalopathy) is an inherited form of cerebrovascular disease that occurs when the thickening of blood vessel walls blocks the flow of blood to the brain. The disease primarily affects small blood vessels in the white matter of the brain. A mutation in the Notch3 gene alters the muscular walls in these small arteries.

Symptoms and disease onset vary widely, with signs typically appearing in the mid-30s. Some individuals may not show signs of the disease until later in life. CADASIL is an autosomal dominant inheritance disorder, meaning that one parent carries and passes on the defective gene. Most individuals with CADASIL have a family history of the disorder.

CADASIL is characterized by migraine headaches and multiple strokes progressing to dementia. Other symptoms include:

• White matter lesions throughout the brain
• Cognitive deterioration
• Seizures
• Vision problems
• Psychiatric problems such as severe depression and changes in behavior and personality

Individuals may also be at higher risk of heart attack.

CADASIL — formerly known by several names, including hereditary multi-infarct dementia — is one cause of multi-infarct dementia (dementia caused by lack of blood to several areas of the brain).

Symptoms usually progress slowly. By age 65, the majority of persons with CADASIL have severe cognitive problems and dementia. Some people lose the ability to walk and most become completely dependent due to multiple strokes.

There is no treatment to halt this genetic disorder. Individuals are given supportive care. Migraine headaches may be treated by different drugs and a daily aspirin may reduce stroke and heart attack risk. Drug therapy for depression may be given. Affected individuals who smoke should quit as it can increase the risk of stroke in CADASIL.