Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy, Type 1

Cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy, type 1 is usually called CADASIL type 1. It is a rare, inherited disease of the small blood vessels in the brain. “Arteriopathy” means disease of arteries. “Autosomal dominant” means a person can get the disease if they receive just one changed (mutated) gene from either mother or father. “Subcortical infarcts” are small strokes that happen in the deep parts of the brain. “Leukoencephalopathy” means damage to the white matter, which carries signals between brain areas. In this disease, a change in the NOTCH3 gene causes the wall of small brain arteries to become thick and unhealthy. Over time, this blocks blood flow, causes many tiny strokes, and slowly injures the brain’s white matter, leading to migraine, strokes, thinking problems, and mood changes. JCN+4MedlinePlus+4NINDS+4

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, often called CADASIL, is a rare genetic brain blood-vessel disease. It is caused by a change (mutation) in the NOTCH3 gene and is passed in an autosomal dominant pattern, which means a child has a 50% chance of inheriting it if one parent has the mutation. This disease mainly affects the tiny arteries in the brain, leading to thickened vessel walls and poor blood flow. Over time, this can cause small strokes, white-matter damage (leukoencephalopathy), thinking problems, mood changes, and migraine headaches.PMC+2JCN+2

CADASIL usually appears in adulthood, often in the 30s–50s. People may have repeated small strokes, problems with balance and walking, memory and attention problems, and sometimes seizures or depression. MRI scans often show white-matter changes and small infarcts deep in the brain, even before symptoms are very strong. There is currently no cure or disease-modifying drug, so treatment focuses on protecting the brain’s blood vessels, preventing strokes as much as possible, and treating symptoms such as migraine, mood problems, and movement difficulties.PMC+2NCBI+2

Other Names

This disease has several other names. The most common short name is CADASIL, which stands for “cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy.” Doctors may also call it NOTCH3-related cerebral small vessel disease, because the NOTCH3 gene is the cause. Some older papers use terms like hereditary multi-infarct dementia or familial subcortical vascular dementia, because many small strokes in the brain can lead to problems with memory and thinking in many family members. In genetic and disease databases it may appear as cerebral arteriopathy, autosomal dominant, with subcortical infarcts and leukoencephalopathy 1, to distinguish it from other similar but less common conditions. Wikipedia+1

Types

Doctors usually do not divide CADASIL type 1 into strict “official” types, but they do see different patterns or stages. These patterns help to describe how the disease looks in different people and at different ages.

1. Migraine-dominant pattern – Some people first show the disease through migraine headaches, often with aura (visual or sensory changes before the headache). These attacks may start in early or mid-adulthood, sometimes long before strokes or memory problems appear. Wikipedia+1

2. Stroke-dominant pattern – In other people, the main feature is repeated small strokes or transient ischemic attacks (TIAs). These usually begin between about 30 and 60 years of age and may happen even when the person has no usual stroke risk factors like high blood pressure or diabetes. PubMed+1

3. Cognitive-dominant (dementia) pattern – Some patients slowly develop problems with memory, planning, and thinking speed. Over time this can become a subcortical dementia, meaning the deeper white matter damage affects thinking and daily function. Frontiers+1

4. Psychiatric-dominant pattern – A group of patients mainly show mood changes, such as depression, apathy, irritability, or other psychiatric symptoms, sometimes even before obvious strokes are seen. Frontiers+1

5. Mixed pattern – Many people have a mix of migraine, strokes, mood changes, and cognitive problems. The exact combination and severity are different from family to family and from person to person. Frontiers+1

6. Early-stage imaging-only pattern – In some individuals, brain MRI already shows white matter damage even when they have no or very few symptoms. This is often found when doctors screen family members of someone who already has CADASIL. PMC+1

These patterns are descriptive, not separate diseases. They all share the same underlying NOTCH3 gene problem in CADASIL type 1.

Causes

It is important to understand that the main cause of CADASIL type 1 is genetic, not lifestyle. Only one basic cause is needed: a harmful change in the NOTCH3 gene. Many of the “causes” below are mechanisms or contributors that flow from this mutation or that make its effects worse.

1. NOTCH3 gene mutation – The direct cause is a mutation in the NOTCH3 gene on chromosome 19. This gene gives instructions for a protein that is important for the health of smooth muscle cells in small arteries, especially in the brain. When the gene is changed, the protein becomes abnormal and harms these cells. Wikipedia+2JCN+2

2. Abnormal Notch3 protein buildup – The faulty Notch3 protein collects in the walls of small arteries as tiny clumps called granular osmiophilic deposits. This buildup stresses and injures the muscle cells in the vessel wall and is a hallmark of CADASIL on electron microscopy. Wikipedia+1

3. Degeneration of vascular smooth muscle cells – Over time, the smooth muscle cells in the vessel wall become sick and die. These cells help control blood vessel tone and diameter. Their loss makes the vessels stiff and narrow and less able to respond to changes in blood flow needs. digitalcommons.library.tmc.edu+1

4. Thickening of the vessel wall (arteriopathy) – As cells degenerate and abnormal material builds up, the vessel wall thickens. The inside space (lumen) of the small artery becomes smaller, so less blood can pass through. This chronic narrowing is a key cause of reduced blood supply to the deep brain. ScienceDirect+1

5. Chronic small vessel ischemia – Because the small arteries are narrowed, the deep white matter of the brain receives less oxygen and nutrients. This long-standing poor blood supply (ischemia) leads to white matter damage and small “lacunar” infarcts. PMC+1

6. Lacunar infarcts (tiny strokes) – Many tiny strokes occur in the deep brain structures (basal ganglia, thalamus, internal capsule, brainstem). Each small stroke kills a small area of tissue. Over years, the sum of these injuries causes problems with movement, thinking, and mood. American Academy of Neurology+1

7. White matter damage (leukoencephalopathy) – The white matter carries signals between brain regions. Chronic ischemia in CADASIL damages this tissue, leading to widespread white matter hyperintensities on MRI and slowing of thinking and movement. PMC+2Frontiers+2

8. Genetic inheritance from an affected parent – Because the disease is autosomal dominant, each child of an affected parent has a 50% chance of inheriting the mutation. Family history of early strokes, migraines, and dementia is a major cause of disease presence in the next generation. MedlinePlus+1

9. Specific mutation location in NOTCH3 – Different mutations in different parts of the NOTCH3 gene can be linked with more or less severe disease. Some variants may lead to earlier strokes or heavier MRI changes, so mutation position itself is a cause of variability in severity. PMC+1

10. Age-related progression – With time, the disease usually worsens because damage from chronic ischemia and repeated tiny strokes adds up. Getting older is not the basic cause, but it allows more time for damage to build. Frontiers+1

11. High blood pressure (when present) – CADASIL does not need high blood pressure to cause strokes, but if a patient does have hypertension, the added stress on already damaged small vessels may increase stroke risk and speed up brain damage. Cambridge University Hospitals+1

12. Smoking – Smoking is harmful for blood vessels in general. In someone with CADASIL, smoking can further injure the small arteries and may increase the risk of stroke and faster decline. Cambridge University Hospitals+1

13. High cholesterol and other vascular risks – While CADASIL can occur in people without any classic stroke risks, having high cholesterol, diabetes, or obesity adds extra stress to blood vessels and may worsen outcomes. Cambridge University Hospitals+1

14. Migraine attacks with aura – Migraine itself is a symptom, not a root cause. But frequent migraine with aura may be linked with brief changes in brain blood flow and may add to the burden of small vessel stress in CADASIL patients. Wikipedia+1

15. Inflammatory or metabolic stressors – Intercurrent illnesses, infections, or major metabolic stresses (such as severe dehydration) can temporarily reduce blood flow or increase clot risk and may trigger events in vulnerable CADASIL vessels. (This is an inference based on general stroke medicine rather than CADASIL-specific trials.)

16. Poor control of blood pressure or diabetes when present – For patients who do have these conditions, poor control adds to vessel injury. The small arteries damaged by NOTCH3 mutation are less able to tolerate extra pressure or sugar damage. Cambridge University Hospitals+1

17. Limited collateral blood supply in deep brain – The deep white matter and subcortical structures rely on long, small arteries with few backup routes. In CADASIL, once these vessels are narrowed or blocked, there is little alternative blood flow, so ischemia is more likely and more severe. American Academy of Neurology+1

18. Enlarged perivascular spaces – In CADASIL, MRI often shows enlarged fluid spaces around vessels in the temporal pole and other areas. These changes reflect chronic vessel wall damage and may contribute to abnormal fluid and waste removal from brain tissue. AHA Journals+1

19. Genetic background and modifiers – Other genes in a person’s genome may modify how strongly the NOTCH3 mutation expresses itself, leading to earlier or later onset or different symptom patterns. This is still under study but is thought to contribute to disease severity. Frontiers+1

20. Delayed diagnosis and missed risk factor control – If CADASIL is not recognized, stroke risk factors such as smoking, high blood pressure, or high cholesterol may not be treated aggressively. This delay is not a biological cause but is a real-world cause of worse outcomes over time. Cambridge University Hospitals+1

Symptoms

The symptoms of CADASIL type 1 can vary widely, even in the same family. However, some features are very common and help doctors suspect the disease.

1. Migraine headaches, often with aura – Many patients first experience recurrent migraine headaches. The aura may include flashing lights, blind spots, tingling, or weakness before the headache. These migraines often start in early or mid-adulthood and can precede strokes by many years. Wikipedia+1

2. Transient ischemic attacks (TIAs) – TIAs are short-lasting episodes where part of the body becomes weak, numb, or unable to speak. Symptoms usually go away within minutes to hours. In CADASIL, TIAs are common and are warning signs that small arteries are blocked or narrowed. PubMed+1

3. Ischemic strokes – Full strokes, where symptoms last longer than 24 hours or leave permanent deficits, are very frequent in CADASIL. They often affect movement, speech, or sensation and usually occur in the deep areas of the brain that control strength and coordination. PubMed+2American Academy of Neurology+2

4. Slow thinking and mental processing (bradyphrenia) – People may notice that thinking feels slower, tasks take longer, or it is harder to switch between tasks. This slow processing often comes from damage to the white matter pathways that connect different brain regions. Frontiers+1

5. Problems with memory and planning – Many patients develop trouble remembering recent events, organizing activities, or planning steps to finish tasks. This “executive dysfunction” reflects subcortical dementia due to white matter damage. Frontiers+1

6. Changes in mood (depression or apathy) – Depression is common in CADASIL. Apathy, which means loss of interest or motivation, can also occur. These mood changes arise from both psychological responses to illness and direct brain circuit damage in mood-related regions. Frontiers+1

7. Irritability or other psychiatric symptoms – Some patients show irritability, anxiety, or even psychotic-like symptoms. In rare cases, CADASIL can first appear with severe psychiatric problems rather than stroke or migraine. Wikipedia+1

8. Weakness of one side of the body (hemiparesis) – Small strokes in the internal capsule or other deep structures can cause weakness on one side of the body, often affecting the face, arm, and leg. This may improve partly over time but can leave lasting disability after repeated strokes. American Academy of Neurology+1

9. Numbness or sensory changes – Damage to sensory pathways can cause tingling, numbness, or burning sensations on one side of the body. These changes may happen with TIAs or strokes and can either resolve or persist. American Academy of Neurology+1

10. Difficulties with speech (dysarthria or aphasia) – Strokes can affect areas that control speech muscles or language. People may slur words (dysarthria) or have trouble finding words or understanding language (aphasia). American Academy of Neurology+1

11. Problems with walking and balance – As white matter damage and small strokes add up, walking can become slow and shuffling. People may feel unsteady or fall more often, especially in later stages of the disease. Frontiers+1

12. Urinary urgency or incontinence – Damage to brain regions that control bladder function can lead to strong urges to urinate, difficulty holding urine, or incontinence, particularly in the advanced stage of the disease. Wikipedia+1

13. Pseudo-bulbar palsy – In severe stages, patients may develop difficulty swallowing, slurred speech, and uncontrolled laughing or crying, known as pseudo-bulbar affect. This reflects damage to pathways from the cortex to the brainstem. Wikipedia+1

14. Fatigue – Many people with CADASIL feel very tired, both physically and mentally. This fatigue can be due to chronic brain injury, depression, poor sleep, and the effort required to cope with cognitive changes. (This is supported by general reports in small vessel disease and patient guides.) Cambridge University Hospitals+1

15. Seizures (less common) – A smaller number of patients may develop epileptic seizures. This usually occurs when strokes or scar tissue irritate the cortex. Seizures are not the main feature but should be considered if there are episodes of loss of consciousness or shaking. Wikipedia+1

Diagnostic Tests

Diagnosing CADASIL type 1 requires careful clinical evaluation, brain imaging, and confirmation of the NOTCH3 mutation when possible. The tests below help doctors decide if CADASIL is likely and rule out other causes of stroke and white matter disease.

Physical Examination Tests

1. Detailed neurological examination – The doctor checks strength, sensation, reflexes, coordination, eye movements, facial muscles, and speech. This exam helps show whether there are old or new signs of stroke, such as weakness, brisk reflexes, or abnormal movements. Patterns of subcortical weakness and reflex changes support the possibility of CADASIL but are not specific. JCN+1

2. Vital signs and cardiovascular exam – Blood pressure, heart rate, and heart and vessel sounds are measured. In CADASIL, strokes may occur even without high blood pressure or heart disease. Finding normal cardiovascular status in a person with many small strokes increases suspicion of a genetic small vessel disease like CADASIL. PubMed+1

3. Speech and language assessment at the bedside – The clinician asks the patient to name objects, repeat phrases, follow commands, and talk freely. This simple exam can detect speech problems caused by past or recent strokes and helps judge severity of brain involvement. American Academy of Neurology+1

4. Gait and balance assessment – The patient is asked to walk, turn, and sometimes stand with feet together or on one leg. This checks for unsteadiness, stiffness, or weakness. A stiff, slow, or wide-based gait suggests damage from subcortical strokes and white matter disease. Frontiers+1

5. Fundus examination (eye exam) – Looking into the back of the eye with an ophthalmoscope allows the doctor to see small blood vessels in the retina. In some small vessel diseases, retinal changes can mirror brain vessel problems. While not specific, this exam helps rule out other causes and gives more information about microvascular health. JCN+1

Manual (Bedside and Functional) Tests

6. Mini-Mental State Examination (MMSE) – This is a short paper-and-pencil test that asks questions about orientation, memory, attention, and language. It gives a rough score of overall cognitive function. In CADASIL, the MMSE may be normal early but usually falls as dementia progresses. Frontiers+1

7. Montreal Cognitive Assessment (MoCA) – The MoCA is a more sensitive test than the MMSE for detecting early problems in attention, executive function, and visuo-spatial skills. It is useful in CADASIL because these subtle changes may appear before severe memory loss. Frontiers+1

8. NIH Stroke Scale (NIHSS) – This bedside scale measures the severity of a stroke by scoring consciousness, gaze, visual fields, strength, sensation, language, and neglect. In CADASIL, it is used during acute stroke episodes to guide treatment and monitor recovery. eMedicine+1

9. Modified Rankin Scale (mRS) – This simple scale rates how much disability a person has in daily life after a stroke, from no symptoms to severe disability. In CADASIL, repeated strokes cause the mRS score to rise over time, helping track disease impact. eMedicine+1

10. Depression and anxiety questionnaires (for example PHQ-9, GAD-7) – These short forms help to measure mood and anxiety symptoms. Because depression and apathy are common in CADASIL, these tools guide treatment and help separate primary mood disorder from cognitive decline. Frontiers+2Rural Neuro Practice+2

Laboratory and Pathological Tests

11. Basic blood tests (blood count, kidney and liver function) – These tests do not diagnose CADASIL directly but are important to rule out other causes of strokes and white matter disease, such as inflammatory or metabolic conditions. This helps ensure that NOTCH3 testing is focused on the right patients. JCN+1

12. Lipid profile and glucose tests – Measuring cholesterol, triglycerides, and blood sugar helps detect common vascular risk factors like high cholesterol and diabetes. Even though CADASIL is genetic, controlling these risks is still important to prevent additional vascular damage. Cambridge University Hospitals+1

13. Coagulation profile (clotting tests) – Tests such as PT, aPTT, and sometimes more advanced clotting panels help exclude other causes of recurrent strokes, such as clotting disorders. A normal clotting profile in a young person with multiple small strokes can increase suspicion of CADASIL. JCN+1

14. Skin biopsy with electron microscopy – A small piece of skin is taken, usually from the upper arm or leg. Under electron microscopy, doctors look for characteristic granular osmiophilic deposits in the walls of small arteries. Finding these deposits strongly supports a diagnosis of CADASIL because they reflect abnormal Notch3 protein accumulation. Wikipedia+1

15. Skin biopsy with NOTCH3 immunostaining – The same or another skin sample can be stained with antibodies that bind to Notch3. Abnormally strong staining in vessel walls supports CADASIL and can be used in centers where this technique is available, sometimes replacing or complementing electron microscopy. Wikipedia+1

Electrodiagnostic Tests

16. Electroencephalogram (EEG) – EEG measures the brain’s electrical activity through electrodes placed on the scalp. In CADASIL, EEG may be done if there are seizures or episodes of confusion. The test can show abnormal slowing or epileptic discharges, helping to guide anti-seizure treatment, although it does not confirm CADASIL itself. Wikipedia+1

17. Evoked potentials – These tests measure the brain’s electrical response to visual, auditory, or sensory stimuli. In some patients with extensive white matter damage, evoked potentials may be delayed, showing slower conduction along damaged pathways. They are not routine but can give extra information on pathway function. (This use is inferred from general small vessel and demyelinating disease assessment.)

Imaging Tests

18. Brain MRI with T2 and FLAIR sequences – MRI is the most important imaging test for CADASIL. It shows bright (hyperintense) areas in the white matter on T2-weighted and FLAIR images, often in the frontal lobes, external capsule, and anterior temporal poles. It may also show lacunar infarcts and microbleeds. This pattern of changes, especially in a person with a family history and early strokes, is highly suggestive of CADASIL. r-n-j.com+3PMC+3American Academy of Neurology+3

19. CT scan of the brain – CT is less sensitive than MRI for white matter disease but is widely available and quick. It can show old lacunar infarcts and rule out bleeding when a patient presents with an acute stroke. In places where MRI is not available, CT may be the first imaging test and may prompt further evaluation for CADASIL. eMedicine+1

20. Magnetic resonance angiography (MRA) or CT angiography (CTA) – These imaging methods show the larger brain arteries. In CADASIL, large arteries are often normal or only mildly affected, while small vessels are damaged. Finding normal major arteries despite many small strokes can support the idea of a small vessel disease such as CADASIL rather than large-artery disease. JCN+1

Non-Pharmacological Treatments (Therapies and Others)

Below are 20 non-drug approaches. These are general strategies used by doctors and therapists to protect brain health and improve daily life. They do not cure CADASIL but can support the person’s function and well-being.

1. Blood pressure control with lifestyle changes
High blood pressure strongly increases stroke risk in CADASIL.ScienceDirect+1 Lifestyle steps include reducing salt, keeping a healthy weight, regular walking, and stress management. These actions help keep blood vessels relaxed and reduce pressure on their walls. Less strain on small brain arteries may lower the chance of new strokes and slow disability. Doctors often combine lifestyle steps with medicines, but the non-drug part remains the foundation.

2. Smoking cessation support
Smoking damages blood vessels and increases risk of stroke and heart disease in all people, and this risk is especially dangerous in CADASIL, where vessels are already fragile. Quitting smoking helps the blood vessels relax, improves oxygen delivery, and reduces clot risk. Counseling, support groups, and structured stop-smoking programs make quitting more successful and protect the brain over the long term.NCBI+1

3. Regular aerobic exercise
Gentle to moderate exercise such as brisk walking, cycling, or swimming several times per week supports heart and brain health. It improves blood flow, keeps weight under control, and can lower blood pressure and blood sugar. For CADASIL, doctors often recommend safe, supervised exercise suited to the person’s abilities to reduce stroke risk and support mood and cognition.NCBI+1

4. Mediterranean-style diet counseling
A Mediterranean-type diet rich in vegetables, fruits, whole grains, legumes, olive oil, nuts, and fish has been linked to lower stroke and heart disease risk in the general population. This eating style supports healthy cholesterol levels, reduces inflammation, and improves blood vessel function. In CADASIL, such a diet is often recommended as a simple, long-term way to support vascular health and brain function.PMC+1

5. Diabetes lifestyle management
If a person with CADASIL also has diabetes or pre-diabetes, healthy eating, weight control, and regular physical activity are crucial. Good blood sugar control reduces damage to small vessels throughout the body, including the brain, and may lower stroke risk. Diabetes educators and dietitians can help plan meals, set activity goals, and monitor progress safely.PMC+1

6. Cholesterol and metabolic risk reduction
Even though statins themselves do not specifically slow CADASIL, controlling overall cholesterol and metabolic health is still important.eMedicine+1 Lifestyle steps include reducing saturated fat, avoiding trans fats, staying active, and managing weight. These steps support healthier vessel walls and may lower risk of additional vascular disease on top of CADASIL.

7. Sleep hygiene and sleep apnea evaluation
Poor sleep and sleep apnea (when breathing stops briefly many times during the night) can raise blood pressure and strain the heart and brain. Good sleep habits, such as a regular schedule and a quiet, dark bedroom, support brain recovery. If there are symptoms like loud snoring or pauses in breathing, doctors may order a sleep study; treating sleep apnea with a device can help protect brain vessels.NCBI+1

8. Physical therapy (physiotherapy)
Physical therapists design exercises to keep muscles strong, joints flexible, and balance as stable as possible. In CADASIL, they help people recover after strokes, improve walking, and prevent falls. Therapy may include gait training, stretching, strength work, and home exercise plans, all tailored to the person’s abilities and fatigue level.PMC+1

9. Occupational therapy
Occupational therapists focus on daily activities such as dressing, cooking, writing, and using phones or computers. They teach energy-saving ways to do tasks, suggest tools to make life easier, and train people to adapt to cognitive or movement changes. This helps people with CADASIL maintain independence at home and work for as long as possible.PMC+1

10. Speech and language therapy
Some people with CADASIL have trouble with speech, swallowing, or language understanding after strokes. Speech therapists assess these problems and provide exercises and techniques to improve communication and safe swallowing. Early therapy can prevent choking, reduce frustration, and support social interaction, which is vital for mental health.PMC+1

11. Cognitive rehabilitation
Cognitive rehabilitation trains attention, memory, planning, and problem-solving skills using simple tasks and strategies. In CADASIL, where thinking changes are common, this kind of therapy may help people use their remaining abilities more effectively. Techniques might include memory notebooks, step-by-step routines, and computer-based training programs supervised by therapists.PMC+1

12. Psychological counseling and psychotherapy
Depression, anxiety, and emotional changes are frequent in CADASIL, both because of the brain changes and the stress of living with a chronic disease. Counseling or psychotherapy offers a safe space to talk, learn coping strategies, and manage fear about the future. Therapists may use cognitive-behavioral therapy or supportive counseling to improve mood and quality of life.PMC+1

13. Family and genetic counseling
Because CADASIL is inherited, families often need clear information about genetic risk, testing, and family planning. Genetic counselors explain how the disease is passed on, what test results mean, and what options are available. This helps relatives make informed decisions and reduces guilt, fear, and confusion around the diagnosis.JCN+1

14. Fall-prevention and home safety programs
After strokes or with balance problems, the risk of falling is higher. Home assessments by therapists can identify loose rugs, poor lighting, or unsafe stairs. Simple changes like grab bars, railings, and non-slip mats, as well as canes or walkers, can greatly reduce injury risk and help people stay at home longer.PMC+1

15. Stress-reduction techniques
Chronic stress can raise blood pressure and worsen headaches and sleep problems. Relaxation techniques such as deep breathing, gentle yoga, mindfulness, and guided imagery can calm the body and mind. For CADASIL, stress reduction is a safe, low-cost way to support vascular health, reduce headache frequency, and improve mood.NCBI+1

16. Migraine trigger management
Many people with CADASIL have migraine or migraine aura. Keeping a headache diary helps identify triggers such as lack of sleep, certain foods, dehydration, or stress. Avoiding triggers, staying well hydrated, and keeping a regular routine can reduce migraine attacks and lessen the need for strong medicines, some of which may affect blood vessels.PMC+1

17. Social support and patient groups
Living with a rare disease can feel lonely. Support groups, whether in person or online, connect patients and families with others who understand. Sharing experiences and practical tips can reduce anxiety, improve adherence to treatment plans, and help people feel more in control.United Leukodystrophy Foundation+1

18. Education about emergency stroke signs
People with CADASIL and their families should learn the warning signs of stroke, such as sudden weakness, face drooping, speech problems, or loss of balance. Quick recognition and fast transport to a hospital can limit damage. Education also includes explaining that some standard stroke treatments, like thrombolytics, may not be recommended for CADASIL, so specialized care is needed.Cureus+1

19. Advance care planning
Because CADASIL can progress over many years, talking early about wishes for future care is helpful. Advance directives and discussions with family and doctors ensure that the person’s values guide decisions if they later cannot speak for themselves. This may cover resuscitation, feeding support, and where they wish to receive care.PMC+1

20. Coordination of care in a specialist center
CADASIL is complex, so coordinated care in a center that understands inherited small-vessel diseases is ideal. Neurologists, geneticists, rehabilitation specialists, and mental-health professionals can work together to make a personalized plan. Regular follow-up helps adjust treatments, monitor new symptoms, and support the family over time.AHA Journals+2NCBI+2

Drug Treatments

Important note: No medicine is currently approved specifically to stop CADASIL itself.NCBI+1 Medicines below are used to manage risk factors and symptoms. Exact drug choice, dose, and timing must always be decided by a doctor, usually a neurologist or stroke specialist, after weighing stroke and bleeding risks in each person.

1. Aspirin (acetylsalicylic acid)
Aspirin is an antiplatelet drug that helps prevent platelets from sticking together and forming clots.FDA Access Data+1 In some people with CADASIL who have had ischemic strokes, doctors may use low-dose aspirin once daily for secondary prevention. It works by irreversibly blocking cyclo-oxygenase in platelets, reducing thromboxane A2 and lowering clot formation. Side effects can include stomach irritation, bleeding, and, rarely, allergic reactions. It must be used carefully and may be avoided if bleeding risk is high.

2. Clopidogrel
Clopidogrel is another antiplatelet drug. It is a pro-drug that becomes active in the liver and blocks the P2Y12 ADP receptor on platelets, reducing platelet aggregation.FDA Access Data+2FDA Access Data+2 Doctors sometimes use it instead of aspirin or in special cardiovascular situations. It is usually taken once daily. Side effects include increased bleeding risk, bruising, and rare severe reactions such as thrombotic thrombocytopenic purpura or allergic responses.

3. Aspirin plus gastro-protective combinations (e.g., aspirin/omeprazole)
For patients who need aspirin but have a high risk of stomach ulcers or bleeding, combinations like aspirin with omeprazole can be used. The aspirin provides antiplatelet effect for cardiovascular and cerebrovascular prevention, while the proton pump inhibitor reduces stomach acid and ulcer risk.FDA Access Data+1 These combinations are usually taken once daily. Side effects can include bleeding, stomach upset, and, rarely, low magnesium or vitamin B12 with long-term acid suppression.

4. Rivaroxaban (for other vascular indications)
Rivaroxaban is a direct oral anticoagulant that blocks factor Xa in the clotting pathway and is used in conditions like atrial fibrillation or coronary artery disease, sometimes together with aspirin.FDA Access Data In CADASIL, it is generally used only if there is another strong indication, such as atrial fibrillation, because of brain-bleeding risk. Side effects include bleeding, anemia, and rarely liver problems. Dosing and timing must be individualized by a specialist.

5. ACE inhibitors (e.g., perindopril, ramipril)
Angiotensin-converting enzyme (ACE) inhibitors are blood-pressure-lowering medicines that relax blood vessels and reduce pressure on vessel walls. They are often given once or twice daily to keep blood pressure in a target range and reduce stroke risk in people with vascular disease.NCBI+1 Side effects can include cough, low blood pressure, kidney problems, and high potassium.

6. Calcium channel blockers (e.g., amlodipine)
Amlodipine and similar drugs relax smooth muscle in blood vessel walls, helping arteries widen and lowering blood pressure. These medicines are usually taken once daily and can help control hypertension, which is an important modifiable risk factor in CADASIL. Side effects may include ankle swelling, flushing, dizziness, or palpitations.ScienceDirect+1

7. Thiazide-type diuretics (e.g., hydrochlorothiazide)
Thiazide diuretics help the kidneys remove extra salt and water, lowering blood pressure and reducing fluid volume. They can be used alone or with other blood-pressure medicines for stroke prevention. Side effects can include low potassium, increased uric acid, and mild blood sugar changes, so regular blood tests are important.NCBI+1

8. Beta-blockers (e.g., propranolol for migraine prevention)
Propranolol is a beta-blocker often used to prevent migraine in the general population and may be used carefully in CADASIL for frequent migraines. It reduces the effect of adrenaline on the heart and blood vessels, stabilizing vessel tone and reducing migraine attacks. Side effects can include tiredness, low heart rate, low blood pressure, and worsening of asthma in susceptible people.PMC+1

9. Antiepileptic drugs (e.g., levetiracetam)
If a person with CADASIL develops seizures, medicines like levetiracetam may be used. These drugs stabilize electrical activity in the brain and reduce the chance of seizure episodes. Levetiracetam is often given twice daily. Side effects can include fatigue, dizziness, mood changes, or irritability. Seizure treatment is tailored to each patient’s pattern and other health issues.PMC+1

10. Acetazolamide (for certain migraine auras)
Acetazolamide is a carbonic anhydrase inhibitor sometimes used off-label in complex migraine or episodic ataxia. It changes acid–base balance and may stabilize neuronal firing in some people. In CADASIL, it may be considered in special situations with disabling aura, under expert guidance. Side effects can include tingling in fingers, kidney stones, and taste changes.PMC+1

11. Topiramate (migraine prevention)
Topiramate is an antiepileptic drug also used to prevent migraine. It modulates several neurotransmitter systems to calm overactive brain networks. In CADASIL, it may reduce migraine frequency but must be used carefully because side effects can include weight loss, tingling, concentration problems, and mood changes. Slow dose increases are usually used to improve tolerability.PMC+1

12. Selective serotonin reuptake inhibitors (SSRIs, e.g., sertraline)
Depression and anxiety are common in CADASIL, and SSRIs such as sertraline are often first-line treatments. They increase serotonin levels in the brain, improving mood and reducing anxiety. These medicines are taken once daily, and effects appear over several weeks. Side effects may include nausea, headache, sleep changes, and sexual side effects. They are generally safer than older antidepressants in people with vascular disease.PMC+1

13. Other antidepressants (e.g., mirtazapine)
When SSRIs are not suitable or effective, other antidepressants such as mirtazapine can be used for mood, appetite, and sleep. Mirtazapine works by blocking certain serotonin and noradrenaline receptors and is often taken at night. Side effects can include weight gain, sleepiness, and dry mouth. Choice depends on symptoms and other medical conditions.PMC+1

14. Cognitive enhancers (e.g., donepezil)
Donepezil is a cholinesterase inhibitor used in Alzheimer’s dementia and sometimes in vascular cognitive impairment. It increases acetylcholine levels in the brain to support attention and memory. In CADASIL, evidence is limited, but some clinicians may try it in selected patients with significant cognitive decline. Side effects can include nausea, diarrhea, muscle cramps, and sleep disturbance.PMC+1

15. NMDA-receptor modulators (e.g., memantine)
Memantine blocks NMDA receptors in the brain to reduce excessive glutamate signaling, which can harm neurons. It is used in moderate to severe dementia of various causes. In CADASIL, it may be tried off-label in patients with significant cognitive impairment, though strong evidence is lacking. Side effects can include dizziness, headache, and confusion in some people.PMC+1

16. Statins (e.g., atorvastatin – for other indications)
Statins lower LDL cholesterol and reduce the risk of heart attack and ischemic stroke in the general population. In CADASIL, studies do not show a specific benefit on disease progression, and guidelines state they should not be used solely to prevent CADASIL-related stroke unless there is another vascular reason.VASCERN+2eMedicine+2 Side effects may include muscle aches and rare liver problems.

17. Pain relievers for headaches (e.g., simple analgesics)
Paracetamol (acetaminophen) and, cautiously, some NSAIDs may be used for headache pain. However, frequent use of NSAIDs or combination painkillers can cause rebound headache and increase cardiovascular and stomach risks.FDA Access Data The simplest effective medicine at the lowest dose and frequency is preferred, under medical advice.

18. Anti-spasticity drugs (e.g., baclofen)
If strokes cause muscle stiffness or spasticity, baclofen may be used to relax muscles by acting on GABA receptors in the spinal cord. It can improve comfort and movement but may cause drowsiness, weakness, or dizziness, so dose increases must be slow and careful. Treatment is often combined with physical therapy.PMC+1

19. Short-term anti-vomiting and vertigo drugs
After acute strokes, some people have dizziness or nausea. Short-term medicines such as ondansetron or vestibular suppressants can help symptoms so patients can eat, drink, and participate in therapy. These are usually used for a limited time only, because long-term use can interfere with brain compensation for balance problems.PMC+1

20. Short-term sedatives for severe agitation (with great caution)
In rare cases with severe agitation, confusion, or insomnia, short-course sedatives or antipsychotics may be given in hospital settings. These medicines calm the nervous system but can worsen confusion, increase fall risk, and affect the heart, so they are used at the lowest possible dose and stopped as soon as safe.PMC+1

Always remember: these medicines are examples of what specialists may use. They are not a self-treatment guide. Only a qualified doctor who knows the individual’s case can decide which medicine and dose are safe.

Dietary Molecular Supplements

Evidence for supplements specifically in CADASIL is limited. The items below are general brain- and vessel-supporting supplements sometimes considered in vascular or neurological health. They must not replace prescribed medicines, and doses should be checked with a doctor.

1. Omega-3 fatty acids (fish oil)
Omega-3 fats such as EPA and DHA help reduce inflammation, improve endothelial (vessel-lining) function, and may modestly lower triglycerides. They are found in oily fish and fish-oil capsules. Typical supplemental doses range from about 500–1000 mg combined EPA/DHA daily, though higher doses may be used for lipids, under medical supervision. Possible side effects include fishy aftertaste, mild stomach upset, and, rarely, increased bleeding tendency at very high doses.

2. Folic acid
Folate helps the body process homocysteine, an amino acid that at high levels can damage blood vessels. Lowering homocysteine may modestly reduce vascular risk in some people. Folic acid is often given at 0.4–1 mg per day, especially if blood tests show low folate or high homocysteine. It is usually well tolerated; rarely, high doses can mask vitamin B12 deficiency, so doctors often check both levels.

3. Vitamin B12
Vitamin B12 is vital for nerve health and blood formation. Low B12 can cause anemia and nerve damage, making neurological problems worse. If levels are low, doctors may prescribe oral doses (often 250–1000 mcg daily) or injections. B12 helps in myelin synthesis and homocysteine metabolism. Side effects are uncommon and it is generally safe, but dosing and route depend on the cause of deficiency.

4. Vitamin B6 (pyridoxine)
Vitamin B6 is another cofactor in homocysteine metabolism. When used together with folate and B12, it may help keep homocysteine levels in a healthy range. Typical doses are small (e.g., 10–50 mg daily), and long-term high doses above about 200 mg per day may cause nerve problems, so medical supervision is needed. It is usually part of combination B-complex supplements.

5. Vitamin D
Vitamin D supports muscle strength, bone health, and immune balance. Low vitamin D is common and may worsen frailty and fall risk. Doses vary widely (for example 800–2000 IU daily), depending on blood levels and local guidelines. Vitamin D acts via nuclear receptors to regulate calcium and many genes. Excess doses can cause high calcium, so blood levels should be monitored if high doses are used.

6. Magnesium
Magnesium plays a role in nerve transmission, muscle function, and vessel tone. Some people use it to help with migraine prevention and muscle cramps. Doses often range from 200–400 mg elemental magnesium per day, taken with food to reduce diarrhea. It can act as a natural calcium antagonist on blood vessels and may stabilize neuronal excitability, but high doses may cause loose stools.

7. Coenzyme Q10 (CoQ10)
CoQ10 participates in mitochondrial energy production and may act as an antioxidant. It is sometimes used for general cardiovascular support or statin-related muscle symptoms. Common doses range from 100–200 mg daily. It may improve energy in some people, but evidence for major clinical benefit is modest. Side effects are usually mild, such as stomach upset or insomnia if taken too late in the day.

8. Curcumin (from turmeric)
Curcumin is an anti-inflammatory and antioxidant compound from turmeric. It may help reduce low-grade inflammation and oxidative stress, which are involved in many vascular and neurodegenerative conditions. Doses vary from about 500 mg to 1000 mg of standardized extract daily, often with piperine to improve absorption. Side effects can include heartburn or diarrhea in some people, and it may interact with blood-thinners.

9. Resveratrol
Resveratrol is a polyphenol found in grapes and berries. It has antioxidant and potential vasoprotective effects in experimental studies, though human evidence is limited. Supplements often provide 100–250 mg daily. It may influence nitric-oxide pathways and protect endothelial cells. Side effects are usually mild, but interactions with anticoagulants or antiplatelets are possible and must be checked by a doctor.

10. Probiotic supplements
The gut microbiome can influence inflammation, metabolism, and possibly brain health through the gut–brain axis. Probiotic supplements contain live “friendly” bacteria such as Lactobacillus and Bifidobacterium species. They are usually taken once or twice per day and may improve digestion, reduce inflammation, and support immunity. Most side effects are mild (gas or bloating). Very ill or immunocompromised patients should use them only under medical supervision.

Immunity-Booster / Regenerative / Stem-Cell-Related Drugs

At present, there are no approved regenerative or stem cell drugs specifically for CADASIL.Springer Link+1 The following points describe general concepts and experimental directions, not standard treatments. Any such therapy should only occur within approved clinical trials.

1. Experimental mesenchymal stem cell therapy
Mesenchymal stem cells (MSCs) from bone marrow, fat, or umbilical tissue are being studied in many neurological diseases. They may secrete growth factors that support blood vessels, reduce inflammation, and protect neurons. Doses and routes (intravenous or intrathecal) vary by trial. In CADASIL, MSC therapy remains experimental; long-term safety and true benefit are unknown, so it should only be done in formal research settings.

2. Induced pluripotent stem cell (iPSC)-based approaches
Researchers can reprogram adult cells into iPSCs and then into vascular or neural cells carrying NOTCH3 mutations. These cells are mainly used in the lab to study disease and screen drugs, but in the future they may lead to personalized regenerative therapies. Any potential treatment would need very careful testing to avoid tumor formation and other risks. For now, iPSC work is a research tool, not a clinical therapy.

3. Experimental endothelial progenitor cell therapy
Endothelial progenitor cells help repair damaged vessel linings. Some studies in other vascular diseases suggest they might support re-growth of healthy microvessels. In CADASIL, this idea is still theoretical and research-level. Infusions of such cells would need strict control, because abnormal vessel growth or clots could occur. There is no approved standard dose or schedule.

4. Immunomodulatory biologic drugs (general concept)
Biologic drugs that modify immune pathways, such as monoclonal antibodies, are used in some autoimmune vascular diseases. CADASIL, however, is primarily a genetic structural vessel disease, not an autoimmune one. At present there is no clear evidence that immune biologics improve CADASIL, and they are not standard care. Any use would have to be inside a trial with clear scientific rationale.

5. Neurotrophic-factor focused strategies
Some experimental drugs aim to increase brain levels of neurotrophic factors, which help neurons survive injury. These might, in theory, support brain resilience in chronic small-vessel disease. So far, no such drug has proven benefit in CADASIL in large trials. These approaches remain part of broader stroke and neuroprotection research rather than routine therapy.

6. Gene-targeted future therapies
Because CADASIL is caused by NOTCH3 mutations, future gene therapies or RNA-based treatments could become possible. These might try to silence the mutant gene or correct its sequence. Any such therapy would require years of research to prove safety and effectiveness. At present, gene therapy for CADASIL is a future possibility, not a current option in clinical practice.Springer Link+1

Surgeries and Procedures

There is no surgery that “fixes” CADASIL itself. However, some procedures may be needed for complications or other vascular problems.

1. Carotid endarterectomy or carotid stenting (if separate carotid disease exists)
If a person with CADASIL also has significant narrowing in a large neck artery (carotid artery) due to atherosclerosis, surgeons may consider cleaning out the plaque (endarterectomy) or placing a stent. This aims to prevent large-artery strokes unrelated to CADASIL. Decisions are complex because CADASIL brains may be more fragile, so specialists weigh risks and benefits very carefully.

2. Ventricular shunt for hydrocephalus
Rarely, strokes and brain atrophy can disrupt fluid circulation, causing hydrocephalus (excess cerebrospinal fluid). A neurosurgeon may place a shunt, a thin tube that drains fluid from the brain ventricles to another body area. This can relieve pressure and improve walking or thinking in selected cases. Risks include infection, blockage, and need for shunt adjustments.

3. Feeding tube placement (gastrostomy)
If severe swallowing problems lead to repeated aspiration or weight loss, a feeding tube directly into the stomach (PEG tube) may be considered. This procedure is done under endoscopy and provides a safe route for nutrition and medicines. It is usually discussed in the context of long-term care planning and the person’s wishes.

4. Tracheostomy in very advanced cases
In rare, very advanced situations with repeated aspiration, pneumonia, or long-term ventilation, a tracheostomy (a surgically created hole in the windpipe) may be needed. It eases airway management and suctioning. Such procedures are part of intensive care and palliative discussions and are not specific to CADASIL but to severe neurological disability in general.

5. Orthopedic surgeries for severe contractures
If strokes lead to fixed joint contractures that cause pain, hygiene problems, or limit seating and caregiving, orthopedic surgeries such as tendon release may be considered. These procedures aim to improve comfort, positioning, and care rather than cure the underlying disease. They are usually planned alongside rehabilitation teams.

Prevention Strategies

Because CADASIL itself cannot be prevented once the gene is present, prevention focuses on reducing additional vascular damage and managing risk factors:

1. Do not smoke or vape, and seek help to stop if you do.

2. Maintain good blood pressure control with lifestyle and, if needed, medicines.

3. Keep blood sugar in the healthy range and treat diabetes carefully if present.

4. Manage cholesterol and metabolic health with diet, activity, and appropriate medicines.

5. Stay physically active with regular, safe exercise, as approved by your doctor.

6. Eat a balanced, mostly plant-based, Mediterranean-style diet.

7. Maintain a healthy body weight and avoid extreme dieting.

8. Avoid excessive alcohol and recreational drugs that can harm the brain and vessels.

9. Learn stroke warning signs and seek urgent care for any sudden neurological change.

10. Encourage at-risk relatives to obtain genetic counseling and early evaluation when appropriate.PMC+2ScienceDirect+2

When to See a Doctor

Anyone with known or suspected CADASIL should be in regular contact with a neurologist or stroke specialist. You should seek medical help:

• When you first learn CADASIL is in your family and want to discuss testing or symptoms.

• If you notice new headaches, especially migraine with aura, or a clear change in headache pattern.

• If you have sudden weakness, numbness, vision loss, trouble speaking, or sudden imbalance—these may be stroke signs and are emergencies.

• When memory, thinking, or mood change in a way that affects work, school, or daily life.

• If you develop seizures, fainting, or unexplained episodes of confusion.

• If you fall often, lose weight, or cannot swallow safely.

• If any medicine causes worrying side effects, such as bleeding, severe rash, or strong mood changes.NCBI+2Cureus+2

Regular follow-up visits allow your doctor to monitor blood pressure, cholesterol, sugar, and neurological status, adjust treatments, and provide counseling for you and your family.

What to Eat and What to Avoid

What to eat

Choose a diet that supports heart and brain health:

• Plenty of vegetables and fruits every day for vitamins, minerals, and antioxidants.

• Whole grains like brown rice, oats, and whole-wheat bread for fiber and stable energy.

• Legumes such as beans, lentils, and chickpeas as healthy protein and fiber sources.

• Fish, especially oily fish like salmon or sardines, for natural omega-3 fats.

• Nuts and seeds in small portions, and olive oil as the main added fat.

• Low-fat or moderate-fat dairy products, depending on your doctor’s advice.PMC+1

What to avoid or limit

Try to limit:

• Foods high in salt, such as processed meats, instant noodles, and salty snacks, which raise blood pressure.

• Foods high in saturated and trans fats, like deep-fried items, fatty red meats, and many commercial baked goods.

• Sugary drinks and sweets that cause blood-sugar spikes and weight gain.

• Heavy alcohol use, which can harm the brain and raise blood pressure.

• Very high-dose supplements or herbal products without medical advice, especially if you use blood-thinners.ScienceDirect+1

Drinking enough water, spreading meals through the day, and avoiding very large late-night meals can also help with energy and sleep.

Frequently Asked Questions (FAQs)

1. Is CADASIL the same as ordinary stroke?
No. CADASIL is a genetic disease of small blood vessels in the brain, caused by NOTCH3 mutations. It leads to repeated small strokes and white-matter damage, often at a younger age than typical strokes. However, people with CADASIL can also have common vascular risk factors such as high blood pressure or diabetes, which add to their overall stroke risk.PMC+1

2. Can CADASIL be cured?
At present, there is no cure and no approved drug that directly stops the disease process. Treatment focuses on reducing stroke risk, managing symptoms, and supporting the person’s function through lifestyle changes, medicines for specific problems, and rehabilitation therapies. Research is ongoing to find disease-modifying and gene-targeted therapies.NCBI+2Springer Link+2

3. How is CADASIL diagnosed?
Doctors suspect CADASIL based on family history, symptoms such as migraines and early strokes, and characteristic MRI findings in the white matter. Confirmation usually comes from genetic testing for NOTCH3 mutations and sometimes from a skin biopsy that shows typical vessel changes.Stroke Manual+2JCN+2

4. At what age do symptoms usually start?
Symptoms often begin in early or middle adulthood, commonly between 30 and 50 years of age, although MRI changes may appear earlier. Some people have migraines for years before any strokes or clear cognitive changes. The course is variable even within the same family.PMC+2JCN+2

5. Is pregnancy safe in CADASIL?
Many women with CADASIL have successful pregnancies, but pregnancy can stress the cardiovascular system. Blood pressure and overall health must be monitored closely, and decisions about antiplatelet therapy or other medicines should be individualized. Genetic counseling before pregnancy can help couples understand inheritance and testing options.JCN+1

6. Can lifestyle changes really help if the disease is genetic?
Yes. While lifestyle changes cannot remove the NOTCH3 mutation, they can reduce additional damage from high blood pressure, smoking, diabetes, and high cholesterol. Studies show that hypertension significantly increases stroke risk in CADASIL, so controlling risk factors is very important.PMC+2ScienceDirect+2

7. Are antiplatelet drugs always needed?
No. Antiplatelet drugs like aspirin or clopidogrel are sometimes used after ischemic strokes, but they can increase bleeding risk in fragile vessels. There is limited evidence that they change outcomes in CADASIL, and thrombolytic agents are usually avoided. Decisions about antiplatelets must be made by a specialist for each person.ResearchGate+3VASCERN+3NCBI+3

8. Should all relatives be tested?
Genetic testing is a personal choice. Some relatives want certainty; others prefer not to know unless they have symptoms. Genetic counselors can explain benefits and drawbacks, including emotional impact, insurance issues, and family planning questions, so each person can decide what is right for them.JCN+1

9. Does CADASIL always lead to dementia?
No. Many people develop some cognitive changes over time, but the severity varies. Some maintain quite good function for many years, especially with good risk-factor control and support. Others develop significant dementia. Early diagnosis, rehabilitation, and mood treatment can help maintain quality of life.PMC+2PMC+2

10. Are statins recommended for everyone with CADASIL?
Current expert guidance states that statins should not be prescribed solely to prevent CADASIL-related strokes. They may still be used if there is another clear indication, such as very high LDL cholesterol or coronary artery disease, following general cardiovascular guidelines.VASCERN+2eMedicine+2

11. Can migraine medicines make CADASIL worse?
Some migraine drugs that strongly narrow blood vessels (for example, certain triptans and ergot derivatives) may carry extra risk in small-vessel diseases, though data are limited. Many specialists use alternative preventive and pain-relief plans instead. All migraine medicines should be chosen by a doctor who understands CADASIL.PMC+1

12. How often should MRI scans be done?
There is no single rule. Doctors often order MRI scans at diagnosis and then as needed to check for new strokes or explain new symptoms. Routine repeated scans without a clear reason may not change treatment, so the schedule should be individualized in discussion with the neurology team.PMC+2NCBI+2

13. Is CADASIL common?
CADASIL is considered rare worldwide, though it may be under-diagnosed. It is the most common single-gene cause of hereditary small-vessel disease, but compared with typical strokes, it is still uncommon. Cases have been reported in many ethnic groups on all continents.JCN+1

14. What research is happening now?
Current research looks at better understanding of NOTCH3 biology, improved imaging markers, and potential targeted therapies or gene-based treatments. Clinical trials are limited but growing. International patient registries and specialist networks (such as European rare-disease networks) help collect data and support new studies.Springer Link+1

15. What is the most important thing a person with CADASIL can do today?
The most powerful steps are usually simple: do not smoke, keep blood pressure and other risk factors controlled, stay active within your limits, eat a healthy diet, take medicines exactly as prescribed, and keep regular contact with a neurologist. Emotional support, education, and planning ahead also make a big difference to quality of life.PMC+2ScienceDirect+2

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: December 21, 2025.