CADASIL: underdiagnosed in psychiatric patients?
OBJECTIVE
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is exclusively related to symptoms of the central nervous system. Retrospectively in up to 15% the initial presentation is psychiatric disturbances. In these cases the diagnosis often is delayed or missed.


METHODS
Two cases of CADASIL diagnosed in a psychiatric hospital are presented.


RESULTS
Both patients were admitted to the gerontopsychiatric department (one because of a suicidal attempt and a depressive episode, the other because of cognitive decline and progressive personal neglect). Brain magnetic resonance imaging (MRI) showed severe leukoencephalopathy in the absence of cardiovascular risk factors. In both cases, diagnosis of CADASIL was made by the identification of specific granular osmiophilic material in skin biopsies.


CONCLUSIONS
Brain MRI should be performed in all cases of late onset of severe psychiatric symptoms. CADASIL should be considered as a possible differential diagnosis whenever a marked leukoencephalopathy is detectable. Diagnosis can be verified by taking a skin biopsy or by specific genetic testing.
Leyhe
T
T
Department of Psychiatry and Psychotherapy, University of Tübingen, Germany. thomas.leyhe@med.uni-tuebingen.de
Wiendl
H
H
Buchkremer
G
G
Wormstall
H
H
D000368:Aged; D001921:Brain / Q000473:pathology*; D046589:CADASIL / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D015897:Comorbidity; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000473:pathology*; D046529:Microscopy, Electron, Transmission; D008875:Middle Aged; D012867:Skin / Q000098:blood supply / Q000473:pathology*