Cadasil pearls

1. Strokes are subcortical many with classic lacunae syndromes

2. False negative genetic tests should prompt skin biopsy for granular osmiophic material in the vascular basal lsmina which is a specific finding

3. MRI finding occur in anterior temporal poles (o'Sullivan sign seen in 90 percent) but also extreme capsule and corpus callosum also are distinctive

4.  Other MRI findings are microbleeds and brain atrophy

5.  80 plus NOTCH3 mutations are identified

6.  Migraine with aura occurs in 30 percent, often in 3rd decade long before strokes