Spontaneous intracerebral hemorrhage in CADASIL.

[cadasil]

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL ) is a rare hereditary small vascular disease and its mainly clinical manifestations are ischemic events . Spontaneous intracerebral hemorrhage (ICH ) involvement in patients with CADASIL is extremely uncommon .A 46 -year -old normotensive Chinese man developed a large hematoma in the left basal ganglia after he was diagnosed with CADASIL 2 months ago , the patient did not take any antithrombotics . Susceptibility weighted imaging at pre-ICH showed multiple cerebral microbleeds (CMBs ) in the bilateral basal ganglia . He experienced migraine at about 10 months post-ICH . To our knowledge , this is the first report of ICH in CADASIL patients with Arg 90 Cys mutation in exon 3 .ICH should be considered when evaluating new attacks in CADASIL patients . Thus , MRI screening for CMBs might be helpful in predicting the risk of ICH and guiding antithrombotic therapy . In addition , strict control of hypertension and cautious use of antithrombotics may be important in this context .