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Occurrence, Risk Factors, and Prognosis of Acute Cerebral Microinfarcts in CADASIL

Xuejiao Men1, Hui Li1, Zhuoxin Guo2

  • 1Department of Neurology, Mental and Neurological Disease Research Center, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.

Annals of Clinical and Translational Neurology
|April 14, 2025
PubMed

Insights

Acute cerebral microinfarcts (ACMIs) are common in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL), especially with patent foramen ovale (PFO). While ACMIs often resolve, they are linked to worse functional outcomes and quality of life.

Area of Science:

  • Neurology
  • Cerebrovascular Diseases
  • Medical Imaging

Background:

  • Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is the leading monogenic adult cerebral small vessel disease.
  • This study focuses on the incidence, risk factors, and prognosis of acute cerebral microinfarcts (ACMIs) within the CADASIL population.

Purpose of the Study:

  • To investigate the occurrence and risk factors of ACMIs in patients diagnosed with CADASIL.
  • To evaluate the prognostic implications of ACMIs on functional outcomes, cognitive performance, and quality of life in CADASIL patients.

Main Methods:

  • Sixty patients with confirmed CADASIL underwent diffusion-weighted imaging (DWI) to identify ACMIs (<5mm hyperintense lesions).
  • MRI follow-up at 1 year assessed ACMI evolution; functional status (mRS), cognition (MoCA), and quality of life (EQ-5D-3L) were evaluated at 6, 12, and 24 months.

Main Results:

  • ACMIs were detected in 20% of CADASIL patients, primarily in white matter.
  • A patent foramen ovale (PFO) significantly increased ACMI risk (OR, 16.429).
  • Most ACMIs resolved by 1 year; however, patients with ACMIs showed poorer functional outcomes and quality of life at follow-up.

Conclusions:

  • ACMIs are a notable finding in CADASIL patients and are independently predicted by PFO.
  • While many ACMIs resolve within a year, their presence correlates with long-term declines in functional status and quality of life.
  • These findings highlight the clinical significance of ACMIs in CADASIL, particularly in the context of PFO.
Abstract

Keywords:
CADASILPFOacute cerebral microinfarcts

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