Table 5.

Treatment of Manifestations in Individuals with CADASIL

Manifestation/
Situation
TreatmentConsiderations/Other
Acute stroke/
TIA
Standard supportive treatment following stroke medicine guidelinesEffect of thrombolytic therapy (IV thrombolysis) unknown; no evidence or rationale for thrombolysis in those w/CADASIL, & risk of intracerebral hemorrhage is probably ↑; see Agents/Circumstances to Avoid.
Migraine Symptomatic treatment; may incl triptans & ergot derivativesNO evidence that triptans or ergot derivatives are contraindicated due to their vasoconstrictive mechanism of action 1
Psychiatric disturbance Standard treatment 2Psychometric & psychiatric eval can be used to evaluate whether apathy (if present) is a symptom of depression or of cognitive dysfunction.

IV = intravenous; TIA = transient ischemic attack

1.

Triptans appear to have the same treatment responses and frequency of serious side effects in individuals with CADASIL as in the general migraine population [Tan & Markus 2016].

2.

No studies have been performed in individuals with CADASIL to determine the effect of the treatment of psychiatric disturbances (e.g. depression) with psychiatric drugs.

From: CADASIL

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