Retinal abnormalities in CADASIL: a retrospective study of 18 patients.
BACKGROUND
CADASIL is an inherited small vessel disease related to Notch3 gene mutations.


OBJECTIVE
To report retinal findings in symptomatic CADASIL patients.


METHODS
Assessment of visual acuity (VA), testing of visual fields (VF), funduscopic examination (FE), and fluorescein angiography (FA) were carried out in 18 symptomatic patients.


RESULTS
No visual symptoms were presented by our patients. VA was normal in all. Ophthalmologic abnormalities were found in 8 patients. VF were normal except for a right hemianopia in one subject due to ischemic stroke. FE and FA revealed significant abnormalities in seven other subjects (mean age: 55 years; range: 39-74): nerve fibre loss (n = 4), cotton wool spots (n = 3), sheathed arteries (n = 1), and tortuous arteries (n = 1). Only one patient with both tortuous arteries and nerve fibre loss had multiple vascular risk factors, and another patient with cotton wool spots was a current smoker.


CONCLUSIONS
FE and FA revealed silent retinal abnormalities in CADASIL patients with nerve fibre loss in 22% and cotton wool spots in 17%. The presence of these abnormal retinal findings does not seem related to the severity of the disorder but may be considered as peripheral markers of this genetic disease.
Cumurciuc
R
R
Department of Neurology, Lariboisiere Hospital, 2, rue A Paré, 75010 Paris, France.
Massin
P
P
Pâques
M
M
Krisovic
V
V
Gaudric
A
A
Bousser
M G
MG
Chabriat
H
H
D000328:Adult; D000368:Aged; D002533:Cerebral Angiography / Q000379:methods; D015161:Dementia, Multi-Infarct / Q000000981:diagnostic imaging / Q000235:genetics* / Q000503:physiopathology*; D005260:Female; D005451:Fluorescein Angiography; D006423:Hemianopsia / Q000175:diagnosis; D006801:Humans; D008297:Male; D008875:Middle Aged; D017354:Point Mutation / Q000235:genetics*; D011518:Proto-Oncogene Proteins / Q000235:genetics*; D000071656:Receptor, Notch3; D011956:Receptors, Cell Surface / Q000235:genetics*; D051880:Receptors, Notch; D012160:Retina / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012189:Retrospective Studies; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields / Q000502:physiology
C499374:NOTCH3 protein, human; D011518:Proto-Oncogene Proteins; D000071656:Receptor, Notch3; D011956:Receptors, Cell Surface; D051880:Receptors, Notch