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[A case of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) in which lomerizine hydrochloride was suggested to prevent recurrent stroke].
[cadasil]
A
60
-
year
-old
man
visited
our
hospital
because
of
left
hemiparesis
in
September
2006
.
Magnetic
resonance
imaging
(
MRI
)
revealed
a
high
-intensity
lesions
in
the
right
corona
radiata
on
diffusion-weighted
images
and
a
high
-intensity
lesions
in
the
basal
ganglia
and
deep
white
matter
on
T
2
-
weighted
images
.
He
recovered
with
no
sequelae
.
Antithrombotic
agents
such
as
aspirin
were
given
to
prevent
stroke
,
but
stroke
recurred
three
times
over
the
course
of
3
years
.
In
February
2009
,
neurological
examination
revealed
right
hemiparalysis
and
dysarthria
.
Dysphagia
and
cognitive
decline
had
been
progressing
gradually
.
We
suspected
cerebral
autosomal
dominant
arteriopathy
with
subcortical
infarcts
and
leukoencephalopathy
(
CADASIL
)
on
the
basis
of
the
clinical
and
family
history
.
An
Arg
75
Pro
mutation
in
the
Notch
3
gene
was
found
,
but
did
not
involve
a
cysteine
residue
.
Antithrombotic
agents
were
ineffective
.
We
tried
lomerizine
hydrochloride
,
which
was
reported
to
prevent
stroke
in
a
patient
with
CADASIL
.
In
Japan
,
lomerizine
hydrochloride
is
used
to
prevent
migraine
and
to
selectively
inhibit
cerebral
artery
contraction
.
During
treatment
with
lomerizine
hydrochloride
(
5
mg
/
day
)
for
more
than
3
years
,
there
was
no
recurrence
of
cerebral
infarction
and
no
further
deterioration
of
cognitive
function
or
MRI
findings
.
There
is
no
evidence
supporting
the
efficacy
of
antithrombotic
agents
in
CADASIL
patients
.
Moreover
,
antithrombotic
agents
have
been
reported
to
increase
the
frequency
of
clinically
silent
microbleeds
on
MRI
in
CADASIL
.
Lomerizine
hydrochloride
might
therefore
be
one
option
for
the
treatment
of
CADASIL
.
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"mutation in the notch3 gene"
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cadasil
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