Memory and Thinking
In a majority of patients, problems in memory and other thinking skills occur. These symptoms are usually mild at first but may become worse in the later stages of the disease. Some treatments are available which may help with memory symptoms.
The most common symptom of CADASIL is a stroke. Strokes are characterized by a number of neurological symptoms including paralysis, loss of sensation, problems walking, slurred speech or other speech problems, etc. These symptoms might improve rapidly (so-called transient ischemic attacks (TIAs)) or lead to more persistent losses (completed stroke). Strokes caused by CADASIL usually occur for the first time between the ages of 30 and 50. However, as with all the other symptoms, there is a great range of variation and individual patients may remain free of symptoms for many years.
Headaches and Migraines
Approximately one-third of patients with CADASIL suffer from migraine-like headaches. The headache attacks often begin between the ages of 20 and 30, but again there is a lot of variability from person to person. Migraines in CADASIL are usually accompanied by an “aura”. Auras are transient neurological symptoms that occur before or during the headache, such as changes in vision, numbness in the hands or feet, and speech problems. A variety of treatments are available for headaches.
Mood ChangesCADASIL patients also frequently suffer from psychological symptoms such as anxiety or depression. It is not uncommon for a patient to respond psychologically to a stroke by becoming depressed, but in many cases this is reversible and treatable. In individual cases psychiatric symptoms such as hallucinations, delusions, anxieties, changes in perception or mood (manic or depressive) may be the first symptoms of this disease. In these patients a specialist should be consulted for therapy.
In a small percentage of patients, epileptic seizures occur but can be treated well with medication. In individual cases, episodes of confusion or disturbances in consciousness have been observed and last for a few hours to days and may be associated with fever or epileptic seizures.