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A 46 year-old man presented with an acute right hemiparesis. His father had died of stroke in his late forties. The patient's younger brother had a history of two ischemic infarcts.
(Top) Diffusion weighted MRI axial scans; (Bottom) flair axial MRI scans. Note the acute infarcts in the deep white matter in the left hemisphere on the diffusion weighted images. On the Flair images, more widespread chronic ischemic change is see bilaterally. In this patient, his strokes were due to a rare condition, Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Cadasil is a familial non-arteriosclerotic, non-amyloid arteriopathy which presents with recurrent subcortical ischemic strokes starting in middle age. The disease has been mapped to chromosome 19q12.
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