title: "CADASIL coma" in an Italian homozygous CADASIL patient: comparison with clinical and MRI findings in age-matched heterozygous patients with the same G528C NOTCH3 mutation.
abstract: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a genetic disorder caused by mutations in the NOTCH3 gene, with a striking variability in phenotypic expression. To date, only two homozygous patients have been reported, with divergent phenotypic features. We describe an Italian CADASIL patient, homozygous for G528C mutation, in whom early manifestation of the disease was migraine, but whose clinical evolution was characterized by a reversible acute encephalopathy followed by full recovery ("CADASIL coma"). Clinical evaluation, MR scan, neuropsychological and neurophysiological investigation did not reveal substantial differences between our homozygous patient and her heterozygous relatives sharing the same mutation, or between our patient and a group of heterozygous individuals with the same mutation but from different families. Skin biopsy identified peculiar features in the homozygous patient, with cytoplasmic pseudoinclusions likely containing granular osmiophilic material (GOM) in the vascular smooth muscle cells, but further studies are necessary to substantiate their possible relationships with CADASIL homozygosis. "CADASIL coma" did not seem to be specific of patient's homozygosis, since it was observed in one of her heterozygous relatives, whereas its pathogenesis seems to be related to peculiar constellations of unknown predisposing factors. The present study demonstrated that CADASIL conforms to the classical definition of dominant diseases, according to which homozygotes and heterozygotes for a defect are phenotypically indistinguishable.
authors.affiliation: Neurology Division, Mazzoni Hospital, Ascoli Piceno, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Ragno
authors.forename: Luigi
authors.initials: L
authors.lastname: Pianese
authors.forename: Manrico
authors.initials: M
authors.lastname: Morroni
authors.forename: Gabriella
authors.initials: G
authors.lastname: Cacchiò
authors.forename: Antonio
authors.initials: A
authors.lastname: Manca
authors.forename: Fabio
authors.initials: F
authors.lastname: Di Marzio
authors.forename: Serena
authors.initials: S
authors.lastname: Silvestri
authors.forename: Cristina
authors.initials: C
authors.lastname: Miceli
authors.forename: Maria
authors.initials: M
authors.lastname: Scarcella
authors.forename: Marco
authors.initials: M
authors.lastname: Onofrj
authors.forename: Luigi
authors.initials: L
authors.lastname: Trojano
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D046589:CADASIL / Q000175:diagnosis* / Q000235:genetics*; D005260:Female; D006579:Heterozygote; D006720:Homozygote; D006801:Humans; D007558:Italy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020125:Mutation, Missense; D032389:Myocytes, Smooth Muscle / Q000473:pathology; D000071656:Receptor, Notch3; D051880:Receptors, Notch / Q000235:genetics*
chemical_list: C499374:NOTCH3 protein, human; D000071656:Receptor, Notch3; D051880:Receptors, Notch