02:20am Sunday 17 December 2017

Devastating Vascular Disorder in the Brain Often Misdiagnosed as Multiple Sclerosis

CADASIL occurs when a thickening of blood vessel walls blocks blood flow in the brain. Migraine headaches are an early symptom of this condition, which progresses to strokes and mini-strokes, depression, apathy, motor disability and executive dysfunction (an inability to plan and organize everyday activities.) The final symptom is dementia.

CADASIL is caused by mutations of a single gene called NOTCH 3. If an individual carries the mutated gene, he or she inevitably will develop the disease, and there’s a 50 percent chance that each of the individual’s children will inherit the mutation and the disease.

Researchers conducted an exhaustive series of genetic, physical and psychological tests and exams on 11 CADASIL patients. “We found a delay in the detection of this pathology and previous diagnostic errors in some patients and their relatives,” researchers wrote. “Multiple sclerosis was the most frequent misdiagnosis.”

The study is published in Revista de Neurologia (Journal of Neurology) in Spain.

The study was a subset of a larger study to determine whether the Alzheimer’s disease drug donepezil (trade name, Aricept®) can help in CADASIL patients. This larger study found there generally was no benefit to the drug.

CADASIL stands for cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. It was realistically portrayed by one of the main characters in the critically acclaimed 2004 movie “The Sea Inside.”

“It is a terrible disease that runs in families, and, unfortunately, we as yet don’t have effective treatments,” said Dr. José Biller, senior author of the study and chairman of the Department of Neurology of Loyola University Chicago Stritch School of Medicine.

There are several reasons why CADASIL is misdiagnosed as MS. Both diseases tend to strike young adults. There are similarities in brain MRIs, and both diseases can cause focal neurologic signs and symptoms.

While there currently are no effective treatments, researchers are making significant progress in better understanding CADASIL, Biller said. “The field is exploding, and there is hope down the road that there will be new treatments for these patients,” Biller said.

Other authors of the study are Dr. Sarkis Morales-Vidal; Christopher Randolph, PhD; Linda Chadwick, BSN, RN; and first author Dr. Rocío Vázquez do Campo.

Based in the western suburbs of Chicago, Loyola University Health System is a quaternary care system with a 61-acre main medical center campus, the 36-acre Gottlieb Memorial Hospital campus and 28 primary and specialty care facilities in Cook, Will and DuPage counties. The medical center campus is conveniently located in Maywood, 13 miles west of the Chicago Loop and 8 miles east of Oak Brook, Ill. The heart of the medical center campus, Loyola University Hospital, is a 569-licensed-bed facility. It houses a Level 1 Trauma Center, a Burn Center and the Ronald McDonald® Children’s Hospital of Loyola University Medical Center. Also on campus are the Cardinal Bernardin Cancer Center, Loyola Outpatient Center, Center for Heart & Vascular Medicine and Loyola Oral Health Center as well as the LUC Stritch School of Medicine, the LUC Marcella Niehoff School of Nursing and the Loyola Center for Fitness. Loyola’s Gottlieb Memorial Hospital campus in Melrose Park includes the 264-bed community hospital, the Gottlieb Center for Fitness and the Marjorie G. Weinberg Cancer Care Center.


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