Case of the Month: April 2026
Case history
- 50-year-old patient presented with a homonymous hemianopia and motor and sensory disturbance.
Click to reveal diagnosis
- MRI showed an acute left thalamic infarct on a background of diffuse leukoencephalopathy affecting the cerebral and capsular white matter, brainstem, and superior cerebellar peduncles. There were no microhaemorrhages.
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CARASAL (cathepsin A-related arteriopathy with strokes and leukoencephalopathy) is a rare autosomal dominant small vessel disease caused by mutations in the CTSA gene, mimicking CADASIL on imaging.