Aspirin-associated intracerebral hemorrhage in a patient with CADASIL

Area of Science:

• Neurology
• Vascular Neurology
• Genetics

Background:

• Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a rare genetic disorder affecting small blood vessels in the brain.
• It typically presents with ischemic strokes, cognitive decline, and mood disturbances.
• Intracerebral hemorrhage (ICH) is an uncommon but recognized complication, with its etiology in CADASIL remaining unclear.

Observation:

• A 39-year-old male with a history of untreated hypertension and diagnosed CADASIL developed acute ICH.
• The hemorrhage occurred two weeks after initiating aspirin therapy.
• Brain imaging revealed a hyperacute ICH in the left temporal lobe, adjacent to a prior hemorrhage site, and evidence of cerebral microbleeds.

Findings:

• The case suggests a potential association between aspirin use, cerebral microbleeds, and the development of ICH in patients with CADASIL.
• The patient's history of hypertension is a significant contributing factor to vascular disease severity.
• Recurrent hemorrhage at a previous site indicates compromised vascular integrity.

Implications:

• This case underscores the need for careful consideration of antithrombotic therapy in CADASIL patients, particularly those with uncontrolled hypertension and evidence of microbleeds.
• Further research is warranted to elucidate the mechanisms linking CADASIL, microbleeds, and ICH to guide clinical management and risk stratification.
• Enhanced vigilance for hemorrhagic complications may be necessary in this patient population.