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A benign, multifocal, nodular and well-circumscribed neoplasm usually seen as a congenital neoplasm or in the first year of life. It is characterized by a biphasic growth pattern and is composed of small, undifferentiated mesenchymal cells associated with branching thin-walled vessels and more mature neoplastic spindle cells with abundant eosinophilic cytoplasm in a collagenous stroma.
No HPO annotations are available for this condition.
CADASIL is a disease of the small to medium-sized arteries, mainly affecting the brain. The presenting symptoms, age at onset, and disease progression in CADASIL are variable, both between and within families. The disease is characterized by five main symptoms: transient ischemic attacks and recurrent ischemic strokes; cognitive decline; migraine with aura; mood disturbance; and apathy. Subcortical ischemic events. Transient ischemic attacks (TIAs) and stroke, the most frequent presentation, are found in approximately 85% of symptomatic individuals . Mean age at onset for ischemic episodes is 47 years (age range 20-70 years) .
There are no generally accepted diagnostic criteria for CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy). A CADASIL diagnostic screening tool has been proposed by , , and .
CADASIL should be suspected in individuals with unexplained white matter hyperintensities and a family history of stroke and/or vascular dementia; however, lack of an apparent family history of CADASIL does not preclude the diagnosis (see Family history). The following clinical signs and neuroimaging findings can be observed in CADASIL.
No approved treatments are currently available for infantile myofibromatosis. The disease remains an area of unmet medical need.
Evaluations Following Initial Diagnosis To establish the extent of disease and needs in an individual diagnosed with CADASIL, the following evaluations are recommended, if they have not already been completed. Table 4. Recommended Evaluations Following Initial Diagnosis in Individuals with CADASIL
No standard international surveillance guidelines for CADASIL exist. Several countries have developed CADASIL guidelines, such as the medical guideline for CADASIL published (in French) by the French Health Authority (HAS). The interval at which individuals with CADASIL should be seen for follow up depends on the severity and type of symptoms and the needs of patients and their care givers.
Follow up by a neurologist with expertise in CADASIL is recommended from the time of diagnosis onward.
1 clinical trial registered. Interventions under study include drug therapy. Pipeline includes 1 PHASE1. Research is primarily industry-sponsored.
32 publications have been identified in PubMed for infantile myofibromatosis. Research spans Case Report / Case Series (72%), Gene Therapy / Novel Therapeutics (13%), and Basic Science / Preclinical (6%).
Research Type | Count | % of Total |
|---|---|---|
Patient case studies | 23 | 72% |
Data assembled from 5 of 12 sources · Last updated Sep 19, 2026, 3:00 PM UTC
European rare disease database
Genetic and Rare Diseases Info Center
Source: GeneReviews — "CADASIL"
Source: GeneReviews — "CADASIL"
The differential diagnosis of CADASIL includes and . Sporadic/Multifactorial Disorders The clinical characteristics and MRI abnormalities in these conditions may resemble those of CADASIL. The presence of temporopolar MRI lesions, the absence of optic nerve and spinal cord involvement, the absence of oligoclonal bands in the cerebrospinal fluid, and the absence of hypertension are critical in this regard . Table 2. Clinical Signs and MRI Abnormalities of Sporadic/Multifactorial Disorders in the Differential Diagnosis of CADASIL
Disorder | Distinguishing Clinical Characteristics | Distinguishing MRI Abnormalities | Temporopolar MRI Lesions | Optic Nerve Spinal Cord Involvement | Oligoclonal Bands in CSF | Hypertension |
|---|---|---|---|---|---|---|
Gadolinium enhancement of lesions | Common | Typical | Yes | Not associated Sporadic small vessel disease incl Binswanger's disease | Hypertension; Absence of AD or AR inheritance in family history; Age of onset: 65 yrs | Involvement of temporal pole is rare |
Involvement of external capsule occurs less frequently | Rare | No | No | Associated Primary angiitis of the nervous system2 | Subacute headache; Multifocal neurologic deficits; Signs symptoms suggestive of systemic vaculitis (peripheral neuropathy, fever, weight loss, rash, night sweats); May occur at any age; median age at diagnosis: 50 yrs | Multifocal infarcts in different vascular territories |
Diffuse gadolinium enhanced lesions | Uncommon | Involvement of:; Spinal cord: 5% of affected individuals | — | — | — | — |
Optic nerve: rare | Occasionally | Not associated AD = autosomal dominant; AR = autosomal recessive; CSF = cerebrospinal fluid; WMH = white matter hyperintensities 1. 2. | — | — | — | — |
Source: GeneReviews — "CADASIL"
System/Concern |
|---|
Evaluation |
|---|
Comment |
|---|
Neurologic | Complete neurologic eval | Standard brain MRI incl FLAIR sequence T2-weighted gradient echo imaging |
Neurodevelopmental | Psychometrics | W/particular attention to executive function Psychiatric/ |
Behavioral | Consider referral to a psychiatrist. | For treatment of mood disorders eval of apathy Miscellaneous/ |
Other | Consultation w/clinical geneticist /or genetic counselor | To incl genetic counseling Family support/resources |
Treatment of Manifestations in Individuals with CADASIL Manifestation/Situation | Treatment | Considerations/Other Acute stroke/ |
TIA | Standard supportive treatment following stroke medicine guidelines | Effect of thrombolytic therapy (IV thrombolysis) unknown; no evidence or rationale for thrombolysis in those w/CADASIL, risk of intracerebral hemorrhage is probably ; see . |
Migraine | Symptomatic treatment; may incl triptans ergot derivatives | NO evidence that triptans or ergot derivatives are contraindicated due to their vasoconstrictive mechanism of action1 |
Psychiatric disturbance | Standard treatment2 | Psychometric psychiatric eval can be used to evaluate whether apathy (if present) is a symptom of depression or of cognitive dysfunction. |
Prevention of Primary Manifestations in Individuals with CADASIL Manifestation/Situation | Prevention | Considerations/Other |
Stroke/TIA | Consider antiplatelet therapy.1 | Effect of antiplatelet therapy in persons w/CADASIL unknown; no evidence or rationale for its use in treatment of CADASIL – though also no evidence that it is contraindicated. Control of vascular risk factors |
Migraine | Consider prophylactic therapy. | Depending on migraine frequency 1. Such as aspirin and clopidogrel No standard international surveillance guidelines for CADASIL exist. Several countries have developed CADASIL guidelines, such as the medical guideline for CADASIL published (in French) by the French Health Authority (HAS). |
Source: GeneReviews — "CADASIL"
The treatment effect of thrombolytic therapy (intravenous thrombolysis) is unknown in individuals with CADASIL. Studies performed in non-CADASIL populations show that increasing cerebral microbleed burden and increasing white matter hyperintensity lesion load is associated with an increased risk of intracerebral hemorrhage after thrombolytic therapy ; therefore, individuals with CADASIL may be at increased risk for intracerebral hemorrhage. In case of a thromboembolic large vessel stroke (i.e., unrelated to CADASIL), the benefit of thrombolysis outweighs the potential risk of intracerebral hemorrhage. Oral anticoagulants could lead to an increased risk of intracerebral hemorrhage in individuals with CADASIL due to the presence of microbleeds ; the prescription of anticoagulants should therefore be carefully weighed. In case of a clear indication for anticoagulant therapy, such as atrial fibrillation or deep venous thrombosis, the benefit of the treatment likely outweighs the potential risk of intracerebral hemorrhage. Smoking increases the risk of stroke in individuals with CADASIL and should be avoided .
Source: GeneReviews — "CADASIL"
Case reports and small-scale observational studies have suggested a beneficial effect of acetazolamide on migraine . Acetazolamide has also been shown to have a beneficial effect on cerebral perfusion [, , , ]. Acetazolamide is not given to individuals with CADASIL on a routine basis, as no large studies have been performed. Several therapeutic approaches are in pre-clinical development: testing in cells and mouse models including immunotherapy , antisense mediated NOTCH3 exon skipping , and treatment with stem cell factor and granulocyte colony-stimulating factor . Search ClinicalTrials.gov in the US and EU Clinical Trials Register in Europe for access to information on clinical studies for a wide range of diseases and conditions.
Source: GeneReviews — "CADASIL"
1 trial found
A consultation with a neuropsychiatrist is recommended when there are symptoms of depression, apathy, or other psychiatric manifestations.
Consultation of other medical specialists (e.g., rehabilitation physician, clinical geneticist, physical therapist, and psychologist) is as required.
Source: GeneReviews — "CADASIL"
Estimated prevalence: Unknown (Unknown prevalence).
New treatment approaches |
4 |
13% |
Laboratory research | 2 | 6% |
Other research | 1 | 3% |
Research summaries | 1 | 3% |
Disease patterns and progression | 1 | 3% |
Ambrosetti I (2026). [PMID: 41486106](https://pubmed.ncbi.nlm.nih.gov/41486106/). *American journal of medical genetics. Part A*. [Review / Meta-Analysis]
Tong K (2026). [PMID: 40145424](https://pubmed.ncbi.nlm.nih.gov/40145424/). *The Journal of hand surgery, European volume*. [Case Report / Case Series]
Holland JE (2026). [PMID: 41552807](https://pubmed.ncbi.nlm.nih.gov/41552807/). *Journal of surgical case reports*. [Case Report / Case Series]
Simmons KL (2026). [PMID: 41528821](https://pubmed.ncbi.nlm.nih.gov/41528821/). *Orbit (Amsterdam, Netherlands)*. [Case Report / Case Series]
Chang X (2026). [PMID: 42145723](https://pubmed.ncbi.nlm.nih.gov/42145723/). *Front Med (Lausanne)*. [Case Report / Case Series]
Tepedelenli̇oğlu HE (2026). [PMID: 42243864](https://pubmed.ncbi.nlm.nih.gov/42243864/). *Orphanet J Rare Dis*. [Case Report / Case Series]
Boulouadnine B (2026). [PMID: 42217546](https://pubmed.ncbi.nlm.nih.gov/42217546/). *Lab Invest*. [Basic Science / Preclinical]
Boccia F (2025). [PMID: 39873217](https://pubmed.ncbi.nlm.nih.gov/39873217/). *Genes, chromosomes & cancer*. [Gene Therapy / Novel Therapeutics]
Lee HC (2025). [PMID: 39973527](https://pubmed.ncbi.nlm.nih.gov/39973527/). *Journal of neonatal-perinatal medicine*. [Case Report / Case Series]
Kubouchi Y (2025). [PMID: 40230826](https://pubmed.ncbi.nlm.nih.gov/40230826/). *Surgical case reports*. [Case Report / Case Series]