title: Cerebral microbleeds in CADASIL.
abstract: BACKGROUND
  Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary arteriopathy leading to recurrent cerebral infarcts and dementia. Intracerebral hemorrhage (ICH) has been described sporadically in patients with CADASIL, suggesting that the affected arteries in CADASIL are not bleed-prone. However, the presence of cerebral microbleeds, which often remain undetected on conventional MRI, has not been determined in CADASIL.
  
  
  OBJECTIVE
  To determine whether cerebral vessels in patients with CADASIL are prone to microbleeding.
  
  
  METHODS
  T2*-weighted gradient echo MRI, which is highly sensitive for visualizing microbleeds, was performed in patients with CADASIL and their family members (n = 63). Known risk factors for ICH were determined for all individuals. On an exploratory basis, the presence of cerebral microbleeds was correlated with demographic variables, vascular risk factors, disease progression, ischemic MR lesions, and genotype.
  
  
  RESULTS
  Cerebral microbleeds were present in 31% of symptomatic CADASIL mutation carriers, predominantly in the thalamus. Vascular risk factors such as hypertension did not account for the microbleeds in these patients. Factors associated with microbleeds were age (p = 0.008), Rankin disability score (p = 0.017), antiplatelet use (p = 0.025), number of lacunae on MRI (p = 0.009), and the Arg153Cys Notch3 mutation (p = 0.017). After correction for age, only the Arg153Cys mutation remained significantly associated with the presence of microbleeds.
  
  
  CONCLUSIONS
  Patients with CADASIL have an age-related increased risk of intracerebral microbleeds. This implies that they may have an increased risk for ICH, which should be taken into account in CADASIL diagnosis and patient management.
authors.affiliation: Department of Clinical Genetics, Leiden University Medical Center, Rijnland Hospital, Leiden, the Netherlands. lesnik@lumc.nl
authors.forename: S A
authors.initials: SA
authors.lastname: Lesnik Oberstein
authors.forename: R
authors.initials: R
authors.lastname: van den Boom
authors.forename: M A
authors.initials: MA
authors.lastname: van Buchem
authors.forename: H C
authors.initials: HC
authors.lastname: van Houwelingen
authors.forename: E
authors.initials: E
authors.lastname: Bakker
authors.forename: E
authors.initials: E
authors.lastname: Vollebregt
authors.forename: M D
authors.initials: MD
authors.lastname: Ferrari
authors.forename: M H
authors.initials: MH
authors.lastname: Breuning
authors.forename: J
authors.initials: J
authors.lastname: Haan
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000175:diagnosis* / Q000235:genetics; D015161:Dementia, Multi-Infarct / Q000175:diagnosis* / Q000235:genetics; D005260:Female; D005838:Genotype; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012680:Sensitivity and Specificity