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Monogenic cerebral small-vessel diseases: diagnosis and therapy. Consensus recommendations of the European Academy of Neurology.

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Peer-reviewed

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Article

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Authors

Arnold, M 
Bersano, A 
Burlina, A 
Chabriat, H 

Abstract

BACKGROUND AND PURPOSE: Guidelines on monogenic cerebral small-vessel disease (cSVD) diagnosis and management are lacking. Endorsed by the Stroke and Neurogenetics Panels of the European Academy of Neurology, a group of experts has provided recommendations on selected monogenic cSVDs, i.e. cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), autosomal dominant High Temperature Requirement A Serine Peptidase 1 (HTRA1), cathepsin-A-related arteriopathy with strokes and leukoencephalopathy (CARASAL), pontine autosomal dominant microangiopathy and leukoencephalopathy (PADMAL), Fabry disease, mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) and type IV collagen (COL4)A1/2. METHODS: We followed the Delphi methodology to provide recommendations on several unanswered questions related to monogenic cSVD, including genetic testing, clinical and neuroradiological diagnosis, and management. RESULTS: We have proposed 'red-flag' features suggestive of a monogenic disease. General principles applying to the management of all cSVDs and specific recommendations for the individual forms of monogenic cSVD were agreed by consensus. CONCLUSIONS: The results provide a framework for clinicians involved in the diagnosis and management of monogenic cSVD. Further multicentre observational and treatment studies are still needed to increase the level of evidence supporting our recommendations.

Description

Keywords

Fabry, cathepsin-A-related arteriopathy with strokes and leukoencephalopathy (CARASAL), cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), cerebral autosomal recessive arteriopathy with subcortical infarcts and leukoencephalopathy (CARASIL), cerebral small-vessel disease, lactic acidosis and stroke-like episodes (MELAS), mitochondrial encephalopathy, monogenic cerebral small-vessel disease, pontine autosomal dominant microangiopathy and leukoencephalopathy (PADMAL), retinal vasculopathy with cerebral leukoencephalopathy and systemic manifestations (RVCL-S), type IV collagen (COL4)A1/2, CADASIL, Cerebral Small Vessel Diseases, Consensus, High-Temperature Requirement A Serine Peptidase 1, Humans, Leukoencephalopathies, Neurology

Journal Title

Eur J Neurol

Conference Name

Journal ISSN

1351-5101
1468-1331

Volume Title

27

Publisher

Wiley

Rights

All rights reserved