Abstract
A 64-year-old man with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) (heterozygous, c.544C>T; p.Arg182Cys) underwent an intracranial high-resolution black-blood protocoled vessel wall MRI (vwMRI). Intramural patchy gadolinium enhancement in the subcortical and leptomeningeal arteries and veins was noted, consistent with the histopathologic findings of CADASIL (figures 1 and 2).1,2 We hypothesize that vwMRI allowed for an in vivo view of the vasculopathy intrinsic to CADASIL. Pending investigation of larger cohorts, this imaging technique may provide a novel mechanism for understanding CADASIL progression and pathogenesis, as well as potentially serving as a biomarker in future disease modification trials and aiding in the differential diagnosis for interpreting clinicians.
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