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PubMed · 16494813

[CADASIL versus multiple sclerosis].

Alan Christian Kimper-Karl·Henrik Boye Jensen·Ole Kristensen
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Abstract

This case history reports on the second family in Denmark to be diagnosed with CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy). Due to symptoms, signs and paraclinical findings, an initial diagnosis of multiple sclerosis was made. However, MRI findings of leucoencephalopathy in the external capsule and anterior temporal lobes together with negative CSF findings and family history raised suspicions of CADASIL. Skin biopsy with granular osmiophilic material (GOM) and genetic testing showing the NOTCH 3 mutation proved the diagnosis. There is considerable variability in the symptoms of CADASIL; however, most often a family history of migraine, cerebrovascular events and dementia in early life is found.

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CADASILDiagnosis, DifferentialFemaleHumansMagnetic Resonance ImagingMiddle AgedMigraine with AuraMultiple SclerosisReceptors, NotchCase ReportsEnglish AbstractJournal Article

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Alan Christian Kimper-Karl, Henrik Boye Jensen, Ole Kristensen. 2006-02-13. [CADASIL versus multiple sclerosis].. https://pubmed.ncbi.nlm.nih.gov/16494813/

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PubMed2005

Peripheral nerve and skeletal muscle involvement in CADASIL.

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is characterized by degeneration of vascular smooth muscle cells (VSMC) of nearly all tissues studied so far. The clinical phenotype of CADASIL shows great variability. The disease is caused by mutations of the Notch3 gene encoding the transmembrane receptor Notch3, which is expressed predominantly in VSMC. In some patients, neuromuscular symptoms have been described. To investigate the fine structural features of peripheral nerve and muscle biopsy specimens in more cases and greater detail, seven electron microscopically confirmed CADASIL patients showing a variable amount of granular osmiophilic material on the surface of VSMC were included in this study. Pathogenic mutations within the cluster region (exon 3 and 4) of the Notch3 gene were identified in six cases. Degeneration and regeneration of nerve fibers in the sural nerves, studied in four cases, was present, although moderate, in all nerve biopsy specimens, whereas an intramuscular nerve fascicle showed more severe changes. Enlarged mitochondria with needle-like calcium precipitates were repeatedly seen. In muscle biopsy specimens, some degree of neurogenic atrophy was apparent in addition to myopathic changes, including occasional ragged red fibers with abnormally large mitochondria, focal tubular aggregates, abnormal terminal cisternae, and myofibrillary abnormalities. Automated sequence analysis of the whole mitochondrial DNA performed in one patient revealed several nucleotide polymorphisms, which were not considered pathogenic. The findings suggest that in CADASIL degeneration of small blood vessels is initiated by defects of the surface membrane of VSMC. Dysfunction of these blood vessels may cause low-grade chronic ischemia with secondary hypoxidosis and a large variety of structural changes noted in skeletal muscle and peripheral nerves, although a primary influence of the underlying genetic defect can not be excluded.

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