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Age: 35

Sex: Male

Indication: Right-sided weakness

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Case #2


Findings

  • Multiple remote small vessel ischemic infarcts involving the bilateral cerebellar hemispheres, left hemipons, bilateral basal ganglia and external capsules, and bilateral periventricular white matter
  • Markedly age-advanced confluent T2/FLAIR signal hyperintensity in the subcortical and periventricular white matter with notable involvement of the bilateral anterior temporal lobes
  • Generalized cerebral volume loss without lobar-specific pattern of atrophy, also advanced for patient age


Diagnosis

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)

Sample Report

No acute intracranial abnormality. Specifically, no evidence of acute infarct.

Multiple remote small vessel ischemic infarcts involving the bilateral cerebellar hemispheres, left hemipons, bilateral basal ganglia and external capsules, and bilateral periventricular white matter on a background of age-advanced confluent T2/FLAIR signal hyperintensity in the subcortical and periventricular white matter with notable involvement of the bilateral anterior temporal lobes as well as generalized cerebral volume loss. For this patient’s age, this appearance is most suggestive of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Recommend genetic testing.


Discussion



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Images

Typical imaging findings for CADASIL: Age-advanced white matter disease (red arrow) with notable involvement of the anterior temporal lobes (yellow arrows) and external capsules and multiple small vessel infarcts involving deep gray structures and deep white matter (blue arrows).



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