AN INHERITABLE STROKE DISORDER PRESENTING WITH UNIPOLAR PSYCHOTIC DEPRESSION: CASE REPORT OF A RARE ENTITY

Abstract

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an autosomal dominant rare hereditary angiopathy that causes stroke in young patients. Most frequent clinical presentations include ischemic strokes, recurrent transient ischaemic attacks and migraine with aura. Psychiatric manifestations are conspicuously rare and especially if present as the only presenting manifestation. Here is a case of a female patient in her fties who was diagnosed with major depressive disorder with psychotic features and was on medication for the same for one and a half years with no improvement in symptoms. She was subsequently admitted due to an increased tendency to self-harm and on day 6 of admission had an episode of seizures, which led us to look for organic causes. After a battery of tests and ruling out various differentials, she underwent an MRI which revealed T2 hyperintense signal in bilateral frontal, temporal, parieto-occipetal, and periventricular white matter. Based on MRI ndings, family history of her father passing away due to a stroke at age 68 and poor response to antidepressants, she was suspected to have CADASIL. She underwent genetic testing which conrmed the same. The clinical course and distinct facts of the case are divulged below.