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Case report: bipolar disorder as the first manifestation of CADASIL.
[cadasil]
Cerebral
autosomal
dominant
arteriopathy
with
subcortical
infarcts
and
leukoencephalopathy
(
CADASIL
)
is
an
inherited
cerebrovascular
disease
,
clinically
characterized
by
variable
manifestations
of
migraine
,
recurrent
transient
ischemic
attack
or
lacunar
strokes
,
cognitive
decline
,
and
mood
disturbances
.
However
,
manic
episodes
have
rarely
been
documented
as
an
initial
symptom
of
CADASIL
and
bipolar
disorder
presenting
as
the
first
manifestation
in
CADASIL
has
not
been
reported
previously
from
evaluations
by
psychiatrists
or
psychological
testing
by
psychologists
.
A
53
year
old
woman
developed
symptoms
of
mania
in
her
50
s
leading
to
a
personality
change
involving
a
continuously
labile
mood
and
irritability
over
a
number
of
years
.
Neuropsychological
testing
revealed
an
intact
memory
,
but
impairment
in
attention
and
executive
function
.
In
the
Rorschach
test
,
she
showed
a
high
level
of
cognitive
rigidity
.
Magnetic
resonance
imaging
findings
were
very
consistent
with
a
diagnosis
of
CADASIL
,
which
was
confirmed
by
genetic
testing
for
NOTCH
3
mutations
.
Atypical
antipsychotics
proved
to
be
helpful
in
treating
her
manic
symptoms
and
for
behavior
control
.
We
present
a
novel
case
of
CADASIL
that
first
presented
as
bipolar
disorder
.
We
contend
that
when
patients
show
a
late
onset
personality
change
or
chronically
irritable
mood
that
deteriorates
over
many
years
,
an
organic
cause
such
as
CADASIL
must
be
considered
.
Further
studies
are
needed
to
better
understand
the
exact
impacts
of
cerebral
tissue
lesions
and
psychiatric
symptoms
in
CADASIL
patients
.
Diseases
Validation
Diseases presenting
"and mood disturbances"
symptom
cadasil
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