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"String hallucinations": a case of Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and

Gertrude Okello1, Norman Poole2, Daniel Chung3

  • 1Liaison Psychiatry Department, North London NHS Foundation Trust, London, United Kingdom.

Cognitive Neuropsychiatry
|May 4, 2025
PubMed

Insights

This case report details a patient with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) experiencing visual and somatic disturbances after a thalamic stroke. Lamotrigine and olanzapine offered some symptom relief.

Area of Science:

  • Neurology
  • Genetics
  • Vascular Neurology

Background:

  • Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a hereditary cerebrovascular disorder caused by NOTCH3 gene mutations.
  • It often leads to hypoperfusion, ischemic events, and lacunar infarcts, particularly in the thalamus, basal ganglia, and brainstem.

Purpose of the Study:

  • To describe a case of CADASIL with a thalamic stroke.
  • To report the resulting visual and somatic disturbances and the patient's response to psychotropic medications.

Main Methods:

  • A single-case report methodology was employed.
  • Clinical records of a 52-year-old male with a confirmed NOTCH3 mutation (c.449A>G p.(Tyr150Cys)) and a left thalamic stroke were analyzed.
  • The patient's response to various psychotropic medications was documented.

Main Results:

  • The patient experienced visual and somatic disturbances following a thalamic stroke.
  • Antidepressants and a cholinesterase inhibitor showed no perceived benefit.
  • Lamotrigine and olanzapine provided the most significant reduction in symptom-related distress.

Conclusions:

  • This case highlights unusual perceptual disturbances in CADASIL post-thalamic stroke.
  • Current CADASIL management focuses on symptom control.
  • Further research is needed to understand the underlying mechanisms and develop targeted treatments.
Abstract

Keywords:
CADASILNOTCH3Somatic hallucinationmultimodal hallucinationstactile hallucinationvisual hallucination

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