Early Schizophrenia with Possible Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarct Leukoencephalopathy (CADASIL): A Case Report

Background: CADASIL is an autosomal dominant disease of small vessels with associated psychiatric disorders and cognitive impairment ultimately progressing to dementia seen in 25% to 30% and 60% of patients respectively. Case Presentation: The patient was a 45-year-old, single, male, unemployed vagrant who was brought to our facility on account of hearing of voices of unseen people discussing about him, odd belief that family members were against him and physical aggression, twenty-nine years prior presentation. He had also been wandering for thirteen years. There was no family history of stroke, dementia, CADASIL and mental illness, neither was there history of chronic medical conditions. There was marked cognitive decline with impairment in activities of daily living, while MRI showed white matter abnormalities in keeping with CADASIL. A diagnosis of early schizophrenia with CADASIL was entertained. Patient was managed appropriately with moderate improvement in symptoms and eventually discharged to a supervised home. Conclusion: CADASIL is an under-diagnosed phenomenon in Psychiatry. The co-occurrence of schizophrenia-like symptoms and marked cognitive decline with white matter MRI changes should raise concern of a rather complex disease entity.